4 Medical Billing Issues Affecting Healthcare Revenue Cycle

by | Oct 5, 2020

Medical Billing is an extremely useful component of medical practice. It constitutes a high gear part of the business cycle. Most importantly, it is the backbone of healthcare revenue cycle management.

Numerous providers will experience a plethora of challenges. Particularly when accurately billing patients as well as payers for the services incurred. It can be a sensitive nerve for these providers.

This, owing to the fact that medical billing involves many stakeholders. Multiple parties are involved. A step forward holds significance. It entails that the previous step has been paid for. Therefore, layers of accuracy are in play. It is necessary to ensure all information has been marked at each stage.

However, effective medical billing is rewarding. As rewarding as it is essential. Effective medical billing guarantees the optimization of healthcare revenue cycle management. It can also go a long way in ensuring the days for accounts receivable are reducing.

Here, we will discuss 4 of the most common medical billing issues that impact the healthcare revenue cycle. As well as some tips to streamline the process.

Delays In Claims Reimbursement Due To Inaccurate Patient Information

The medical billing process is initiated from the basics. Specifically, from the first line of communication between the healthcare institution and the patient. The front-end staff take care of the collection rituals. Such as patient information.

Information is the foundation of this process. Ascertaining accurate information begins from the root. From the scheduling and registration of patients. If there occurs an error in this data, the claim submission can come back to haunt the staff.

Keeping your patients happy is vital. Ensuring a flawless process will save trouble on part of your patients. The claim should be cleared judiciously.

Not only this. Staff should also be validating the status of health insurance for the patient. As well as what coverage is being offered.

Eligibility issues are one of the top hurdles when considering claim rejections. It’s not about the forms being filled. Or the questions being asked. What matters is simple. Are the right questions being asked?

This could save everyone a lot of hassle. Regular training should be held for front line employees.

Outsourcing to a company offering one of the best medical billing services could benefit your enterprise. Especially since they often provide customized medical billing services.

Collection Issues Due To A Lack Of Understanding Of Patient Responsibility

What is the primary aim of medical billing? To seamlessly collect the full sum for all services involved in the process. However, this collection is not as simple as it may seem. Recently, there has been an increase in patient financial responsibility. This can lead to collection issues when there exists a lack of information.

Large numbers of people select a high deductible insurance plan. This shifts more responsibility to the patient than the payer.

Many providers have to wait a month or longer for the patient to pay. This should not be the case.

There is a way to prevent this. And boost patient revenue. This lies in placing the groundwork for better implementation policies. Policies that allocate responsibility. They should include an estimation of the costs. Patients should be informed, beforehand, of their fiscal responsibility.

Another method would be to boost the readability of patient bills. Medical jargon is indecipherable to patients. Develop bills that are easy to comprehend. This is a viable solution to the problem.

Administrative Burden Leads To Higher Number Of A/R Days; Manual Processes

Submitting a claim is complex. It is not the magic push of a button. To name a few aspects, robust data collection is involved. Efficient communication channels have to be established. Denial management procedures need to be streamlined.

It is an exceedingly complicated process. A higher number of providers are now leaning towards data-driven care models.

Yet, some providers are still running manual. It is a labor-intensive task. It eats up resources. And the valuable time that could be spent constructively.

The automation of medical billing processes should be the norm now. It could streamline the entire process. By collecting reimbursements from rejections. On-time. By reducing write-offs. And managing resolutions.

Key performance indicators would reveal themselves. Organizations could better manage and oversee all processes involved.

Imprecise Coding Is A Major Obstacle

The ICD – 10 implementation was groundbreaking for most healthcare organizations. Yet, problems persist in coding. Specifically, inaccurate coding.

Some of the top coding challenges span the incorrect application of seventh characters for trauma codes. The improper procedural codes pertaining to a diagnostic group. Incorrectly identifying respiratory failure. And many others.

Coding absolutely has to be error-free. If that is not the case, you will most likely see a spiral in claim denials.

Again, the training of front-line workers in the intricacies of ICD – 10 should be conducted. Involve one of the top medical billing companies in your region for enhanced results.

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