16 Feb 4 Medical Billing Issues affecting Healthcare Revenue Cycle
Medical billing is the backbone of the healthcare facility. Accurate medical billing is important for healthcare revenue cycle management, and providers face many challenges when billing healthcare companies and patients for services performed.
The medical billing process is a difficult thing for healthcare providers because it involves many healthcare stakeholders, and each billing step relies on the previous interaction. Healthcare facilities must communicate across departments and payers to ensure crucial information is properly captured during this process.
Effective medical billing is essential for reducing days in accounts receivable and optimizing reimbursement. Here are the four most common medical billing issues for providers and companies.
Number 1: Failure to Capture Patient Information – Leads to Claim Reimbursement Delays
The medical billing process starts at the initial contact between the receptionist and the patient. During this interaction, the front-end staff should collect and document accurate patient information. The patient information is necessary for the foundation of billing and collections. From a revenue cycle perspective, the most accurate patient information begins during patient scheduling and registration. This information is needed to file claims and bill the patient for balances.
The last thing your healthcare facility needs is to get a claim submission kicked back due to inaccurate patient information. When the office workers get the right information up front, it can save much heartache and work for the patient, family, and medical billers. Ensuring that the patient’s demographic information is correctly entered into the billing system can save time later down the road. It is also necessary for the office staff to verify health insurance coverage.
Number 2: Neglecting to Inform Patients about Financial Responsibility
If your billing company or office worker does not inform the patient about financial responsibility, it could mean collection issues for your healthcare facility. The main goal of medical billing is to collect all monies related to services rendered, but many organizations experience more issues with collecting patient payments due to an increase in patient financial responsibility.
Approximately 90% of the 13 million people participating in a 2016 open enrollment period selected a high-deductible insurance plan, according to the Centers for Medicare and Medicaid Services. This increase in high-deductible plans shifted the payment responsibility to the patient rather than the payer. The office workers should inform patients up front that they will likely be responsible for their healthcare expenses.
To help boost patient revenue, healthcare companies should implement strict financial policies that include estimation of service costs, collecting some of the balance during the patient visit, and informing patients regarding their financial responsibility. High deductibles mean the patients will likely have to pay for their entire bill.
Number 3: Manual Claims Management Processes create Administrative Burden and more Accounts Receivable Days
Submitting a claim involves more than just clicking a stroke of the keyboard. Healthcare providers must engage robust data collection tools, create effective communication channels between front office staff and clinical staff, and streamline their denials management procedures. For the entire healthcare facility, claims management is a complex process, as more providers are transitioning to data-driven and value-based care models. Regardless, some providers are still handling denials manually.
There is much labor associated with managing claim denials, and many complexities circle around submitting claims. Healthcare organizations should implement denial management procedure guidelines to streamline this process. An automated medical billing and claims management system will help providers retrieve maximum reimbursements for denials and rejections in a timely manner.
Number 4: Inaccurate Coding remains a Top Medical Billing Error
The ICD-10 implementation process has gone smoother than expected for most healthcare facilities. However, coding inaccuracies are still a significant challenge for healthcare providers. The American Health Information Management Association has identified the top coding challenges, which include:
- Incorrectly applying the 7th characters for fracture and trauma codes
- Improperly using procedure codes that drive a diagnostic related group (DRG)
- Mistaking the use of guidance tools
- Misidentifying respiratory failure
- Insufficiently documenting devices, components, and grafting materials
Mistakenly or incorrectly coding a medical service could lead to an uptick in claims denials. Therefore, healthcare organizations must adequately train clinical staff regarding ICD-10 updates and urge front office workers to communicate with providers when they find documentation issues.
Medical Practice Management Resources has been a top medical billing and coding company for over ten years, working with all specialties and facility billing with exceptional results. Not only do they offer the best physician billing specialists, but they also help with operations efficiencies. Call us today!