5 Top Challenges in Medical Billing

Medical billing is the practice of submitting claims and following them up with health insurance companies to get reimbursement for the services given by a healthcare professional. To put in other words, medical billing is where medical service is converted into a billing claim.

Every step of medical billing is critical to ensure the reimbursement of healthcare practice. If any of the processes are skipped or performed poorly, it might hurt the revenue cycle of the practice.

Healthcare providers who do not streamline their medical billing procedures threaten their practice’s financial viability. They may, however, enhance reimbursement and optimize their revenue cycle by concentrating on resolving typical issues in the process.

The following are some of the most important challenges in medical billing:

Refused Claims

When a claim is processed, but rejected by a payer, it is called claim denial. Soft, harsh, avoidable, clinical, and administrative denials are the five types of denials. The majority of refused claims are avoidable, and more than half of them can be resubmitted once they’ve been fixed.

Patient Ineligibility

Patient eligibility is probably the most common reason for refusing claims, which means the service submitted for payment isn’t covered by the insurance plan for which it’s being billed. The status and coverage of a patient’s health insurance must be verified by front-office staff.

Information Breach

Some medical practices continue to complete their denial management process by hand, which typically leads to boost human errors and a lack of transparency. A claim can be refused even if only a small amount of patient information is not correct or complete.

Lack of Automation

Legacy billing systems with manual claim processing take a long time and extends the time it takes for a claim to be processed. Advanced claims reporting and tailored decision support are not available to healthcare providers who do not mechanize their medical billing process.

Lack of Technology

Medical practices are doubtful to be able to speed up their denial management and receive revenue owed to them by patients and payers without the use of technology to properly prioritize, manage, and channel claims. Even if it is knowledgeable in the procedure, the lack of appropriate technology to handle claims makes it hard to deal with them successfully.

Medical billing procedures used to be done using paper-based methods and handwritten records, but with the progress of health care industry technologies, the process has been transformed into an electronic one. This has led not only to saving time and money but also minimizes human or administrative errors.