Top 4 Medical Billing Issues…and How to Resolve Them

Medical billing issues show up everywhere nowadays. It's not just in healthcare, it's showing up in just about every industry imaginable.

It’s not just in healthcare, it’s just about in every industry imaginable. Dealing with insurance companies, third-party suppliers, and financial institutions is incredibly complex, utterly convoluted, and in many cases labyrinthine. It’s a red-tape like Gordian knot that makes us question our sanity. In medical billing, these issues are even more tangled and manifold.

Indeed, they are mind-bogglingly bureaucratic and can fray anyone’s nerves.

Thankfully, today, healthcare providers that face the many challenges in medical billing can rely on outsourced services. These include medical billing companies, and extremely helpful software to lighten their workload and optimize their invoicing practices.

What Is Medical Billing?

The minute insurance companies came into being, and those very same ones started offering medical insurance, was the very same minute medical billing was born.

In the United States, medical billing is a cornerstone practice of our current health system. Medical billing is the process by which a medical practitioner or healthcare provider obtains insurance information from a patient, fills out a claim, and later files that claim with a health insurance company. It’s the main method by which a doctor, a hospital, or a healthcare specialist receives payment for services rendered — this includes treatments, consultation, testing, procedures, etc.

Medical billing is normally performed either by the practitioner or by their staff, depending on the size of the healthcare institution or office. It’s a critical part of any practice since a lot of their profits and operational cost come from what they obtain from those claims.

Medical billing is also an extremely complicated procedure. It demands a lot of time and patience. It takes into account intricate medical coding reports, certifications, obscure jargon, byzantine auditing, and in-depth knowledge of each insurance company’s technological platform.

For decades, we did all of our medical billing by paper. Now, thanks to the onset of the internet, and dedicated software — such as medical practice management apps — it has become possible to effectively manage large amounts of claims.

Several companies have risen offering full portal solutions and cost-effective methods to rapidly solve most medical billing issues. This in turn has helped healthcare providers, lowering their bottom line — since they have to employ staff members with a medical information science and technology background — and boosting their profits by streamlining their returns.

Challenges in Medical Billing

Following up a claim with a health insurance company in order to get a fast and prompt reimbursement for your services is full of pitfalls.

This backbone of any practice is full of hazards that can ultimately foil your efforts and place a claim into slug mode. Healthcare providers that disregard this essential part of their operation threaten their practice’s financial viability.

A knowledgeable biller, staff member, or service can do wonders for your practice and truly streamline your revenue performance.

The following are some of the most important and hair-raising medical billing challenges you might encounter.

1. Stalled Payments

The slightest medical billing issue — something as innocuous as a wrong zip-code address — can stall your payments.

Medical billing claims are full of details and in many cases, the devil lies in those details. The slightest error on your biller’s part can end up hurting you. You will need to redact, edit or redo the whole claim and once more place it into the system.

Software, and third-party companies, check, recheck, triple check, and even use advanced AI to scan a claim before delivering it to the insurance company. This ultimately diffuses the possibility of human error and actually helps increase your chances of getting a fast reimbursement by 96%.

2. Filing Multiple Claims

How many patients did you see today? For that matter how many did you see in a week? What about a month?

Each of them has its own portfolio, insurance company, and intricate medical billing requirements. This means that an already complicated process simply gets even more complicated due to the volume of claims.

Your staff members need to file each and every claim. In most cases the more they have to draw up, the more likely it is that they will drop the ball on one or two.

3. Refused Claims

When a medical claim is processed it may actually be rejected by the payer. We call this a claim denial.

In many cases, this turn of events is completely avoidable through the use of the software. The majority of the claims can be fixed and resubmitted. However, in doing so, you’re facing revenue loss.

In many cases, unless your staff made a mistake in checking patient eligibility, these refuse claims can probably be fixed with a quick edit. Information gaps are a common medical billing issue and one that is typically a result of human error.

4. Lack of Resources

Manual claims take a long time and this ends up extending your reimbursement period. While this is taking place, your practice is hemorrhaging money.

The biggest issue when it comes to revenue loss is the lack of resources you have for medical billing.

Plenty of healthcare providers still use legacy billing systems — traditional means, the most famous of which is manual claim processing.

Today, with the advances in technology and outsourcing the old ways have truly become archaic and redundant. They lack automation, which is critical to today’s medical billing standards. Typically, they don’t prioritize technology — including AI algorithms and optimized software. They don’t take into account third-party services. Many of these are composed of medical billing professionals that are well versed in modern practices and policies.

Solving Today’s Medical Billing Problems

The software does wonders to the way a practice approaches most of the current challenges in medical billing.

They truly optimize your revenue stream, hijack (for the better) your policies when it comes to this bureaucratic maze, and can give you much-needed peace of mind.

As a practitioner and healthcare provider, you most likely entered the field to help your patients and provide comfort and aid to their worries and woes. You probably weren’t hoping to spend endless hours dealing with paperwork.

Effective medical billing is essential to stay afloat. It’s vital to better your practice, to really maximize your profits…but it’s not why you became a doctor. Today, software and third-party services can take that key factor off your hands.

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