5 Challenges in Medical Billing

Medical billing is an important part of Revenue Cycle Management (RCM) in the health care industry. The process involves complex procedures including form submission, follow up, request for claims, and more. Tracking claims, insurance verification, collections, and payments can be very frustrating for the health care provider since the system is fraught with many challenges.

The reality is that when errors in medical billing are pulled up in auditing, the health care provider has to face unnecessary issues and cost overheads. So, it’s imperative to understand the challenges in the medical billing process and take immediate steps to improve its throughput.

Listed below are some of the challenges that affect the medical billing process, which needs to be overcome to expedite revenue flow.

1. Non Payment of Bills

An important challenge in medical billing is to collect payments from patients. To overcome this, health care providers must first set up a payment policy to increase the chance of collecting payments. Providing a simplified bill, without any medical terms, also helps in better payment collections.

2. Rejected Claims

Research studies have shown that 22% of claims were rejected, and less than 50% of them were never re-submitted. Most often, the health care provider finds the refiling process to be a time-consuming one, which ultimately delays payments and claims.

3. Coding Errors

Inaccurate coding has been cited as one of the top reasons for medical billing challenges. Mismatch in diagnostic codes, errors in modifiers, usage of wrong codes, inaccurate patient information, and failure to use updated code sets are reasons for coding errors, leading to rejected claims and payment denials.

4. Insufficient Patient Information

In medical billing, it’s important to start collecting data from the time the patient gets admitted. This helps in timely capture of all the necessary information to make the billing process as efficient as possible. At this point, verification of the patient’s health insurance status also needs to be assessed in order to reduce the possibility of a rejected claim.

5. Manual Processes

The approximate spending for claims processing, billing, and revenue management in the healthcare industry is $400 billion. Following manual processes for claim submission and re-appeals makes the billing process error-prone, delaying timely payments for the health care provider. To overcome this issue, health care providers can implement an automated system for seamless processing of bills and claims.

Challenges in medical billing lead to significant revenue loss for the health care provider. Reports say, each year, companies lose as much as 11% of their revenue due to non-payments and underpayments. An experienced, professional partner can help counter these challenges and streamline the billing processes.

If you’re looking at ways to improve the medical billing process and drive more revenue for your business, Allyhealth can be the right choice. We can help you take care of various administrative tasks to expedite revenue and reduce the total cost of operations. If you’d like to explore working with us, drop us a line and our experts will get back to you.

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