Posted by Physician billing is one of the most critical parts of revenue cycle management but is often fraught with complexities, which lead to a claim getting denied, face delays in payment, and revenue losses. An error in coding, documentation, or compliance with payer policies can have a lasting adverse effect on the financial status of a medical practice. To optimize collections while having a smooth billing process, healthcare provides need to be aware of the most common challenges in physician billing and take proactive measures in tackling them.
In this blog, we will highlight several important issues that impede the efficient medical office billing system and how availing of expert physician billing solutions could help optimize reimbursement.
1) Inadequate Medical Coding and Documentation
One of the most common culprits for claim denial is deficient provider coding because the range of services performed by any physician is wide and hence, the need to assign a unique CPT, ICD-10, or HCPCS code to every piece of service. Examples include:
- Incorrect emissions modifiers
- Upcoding
- Undercoding
- Medical necessity not documented
Included among the reasons for rejected claims or reduced payouts is coding errors; hence, such alignment minimizes erroneous claims by putting added importance on coding accuracy and compliance by a professional physician billing company.
2) Changing Policies and Regulation of Insurance
Policies of insurance carriers like Medicare and Medicaid are often revised regarding the reimbursement rates and coding. For in-house billing teams, it is really a challenge to keep up with these changes and they tend to create errors in claim compliance and revenue loss.
Day-in-and-day-out updates on the thrust of policy shifts and regulatory changes on billable items/work from a trusted provider of physician billing services keep all claims compliant with the current standards in the industry.
3) Claim Denials and Lack of Follow-up
If not taken care of properly, denied claims can have a great revenue draw on a practice. Such denial reasons most typically include the following:
- Duplicate billing
- No prior authorization
- Insurance expired
- Lack of patient data
Most medical offices do not have the necessary staff to track, analyze, and appeal denied claims effectively. Partnering with a physician billing company for a structured denial management process that increases reimbursement levels is recommended.
4) Lethargy to Payments or Unpaid Claims
Timely submissions of claims are critical to maintaining cash flow consistency; however, there are certain problems associated with it such as incomplete documentation, snapshots of bad patient information, and other ineffective claim tracking. Medical office billing needs to follow up daily with the payers and keep it enabled for claim processing and payment.
5) Insufficient Credentialing and Enrollment
The step required for a physician to be paid back by insurance companies is credentialing. Otherwise, if a physician is not credentialed correctly or their credentials have expired, claims will be denied, which can be a major loss of revenue.
A good physician billing services provider makes sure that credentialing processes are done in an efficient way to avoid loss of revenues because of payer enrollment issues.
6) Absence of Effective RCM
Currently, a lot of physician practices have inefficiencies regarding revenue cycle management, resulting in income leakage. Loss of potential revenue through inefficiency in billing workflows is observed in which:
- There is increased claim rejection
- Collection accounts receivables (AR) days take a long
- There are poor collections from patients
A physician billing company can optimize RCM by ensuring automated workflows that diminish claim denials while ensuring reimbursements are completed in a timely manner.
7) Non Compliance Issues and Risk of Audit
Audit and financial penalties may occur due to billing errors and noncompliance to HIPAA and payer guidelines. Thus, billing professionally requires a rigorous keeping of records, accuracy of claims submitted, and compliance with standards.
Consider reduction of exposure to audit risk and ensure proper claims submissions through outsourcing billing to a compliant physician billing solutions provider.
8) Obstacle to Patient Collections
More patient responsibility burden is placed on high-deductible health plans (HDHPs); therefore, more debts for co-pays, deductibles, and balances due have caused shortfalls in revenue in many practices.
Having clear patient financial policies, accommodating different payment methods, and utilizing services from an expert medical office billing company would be a plus in improving patient revenue collections and overall revenues.
Rampant claim denials and delays in reimbursements usually come with trying to manage physician billing in-house. Outsourcing to a physician billing solution means less or no errors in billing, adherence to insurance policies, and eventually, a smooth cycle of revenue. So, say goodbye to these difficulties and take the practice outsourcing physician billing services to a dedicated physician billing company. It could be a veritable game changer for your practice.