23 Sep How To Fix 7 Common Medical Billing Problems
Counteract these medical billing problems to boost revenue
Serious medical billing problems can stand in the way of your practice getting its claims paid. Because your practice’s fiscal wellbeing depends on revenue flow from reimbursement, it’s crucial that you get claims management right. But what are the roadblocks that might stand in your way?
Risks in Medical Billing
Before we begin discussing medical billing problems and how to avoid them, let’s review some of today’s most common risks in medical billing.
- You can be responsible for data security risks that could infringe on patient privacy or lead to the loss of sensitive patient data.
- You can get in trouble because you’re unaware of constant updates to healthcare policies.
- You can commit compliance violations by improperly using modifiers or unbundling services.
- You can make coding errors by using the wrong procedure codes, upcoding, and undercoding.
- You can trigger claim denials by submitting incorrect information or by failing to follow requirements.
Let’s see how you can avoid those risks.
You didn’t get prior approval or pre-authorization for a patient procedure or treatment.
Problem: Many procedures require prior authorization. Failure to do so will result in a surprise bill, which will negatively impact patient satisfaction.
The answer: Call the insurer! Ask what the latest rules are relating to this treatment. It should become second nature to your staff to document prior approval.
You‘re non-complaint with insurance company policies or guidelines.
Failure to fulfill compliance rules that support strict rules governing patient privacy and safety could result in legal jeopardy. This underscores the importance of knowing the latest changes in regulations and policies and adhering to them. Here’s an example:
Problem: in the last decade, the changes in coding standards has resulted in 500% more individual codes that healthcare providers had to contend with 10 years ago.
The answer: Keep up to date with compliance changes by creating a compliance team and establish a training program. Audit claims to assure compliance, and if necessary, engage a third-party provider who can support your compliance goals.
Problem: A major issue is guaranteeing you are HIPAA-compliant and enforcing patient data security. The security of your patients’ data can be compromised if an illegal actor violates confidential or personally identifiable information (PII) or if someone merely makes a careless error.
The answer: Invest in staff training and create strict access controls. Periodically assess your risk level and guarantee you’re protecting patient information by creating well-defined policies and procedures.
You’re unaware of the latest coding rules.
Problem: You’re not current with the most recent updates to the International Classification of Diseases coding regulations
The answer: Use modern technology like coding and Electronic Health Record software to power your processes with automation and be up to date with new coding rules.
Your coding is erroneous or in conflict with the diagnosis.
Problem: Many practices assign an inaccurate diagnosis code or insert a code that fails to align the symptoms described in the documentation.
The answer: Quality assurance! Perform though going quality checks for every coded bill before you process the codes before you bill.
You input information that was either lacking in detail or incorrect.
Problem: It’s easy to make a typo when recording the personal information of a patient or the number of their insurance policy—but your claim will be rejected.
The answer: Again, quality assurance. Train the staff of your front office that it’s imperative to capture ensure patient information that’s correct and not missing important details as soon as the patient contacts your office to make an appointment.
Your claim contains erroneous or incomplete information.
Problem: If, in his/her documentation, a physician fails to furnish sufficient details concerning the treatment plan, symptoms, and examination results of the patient in question, it can result in mistaken coding and botched billing.
The answer: Create a comprehensive training program for your staff members, coders, and physicians, so they know how to record correct documentation and understand coding procedures.
You accidentally bill for patient care considered experimental or non-covered.
Problem: You didn’t realize it—but you’ve billed for a type of patient care that’s excluded by your patient’s insurance policy. The insurer is now saying it’s regarded as non-covered or experimental treatment.
The answer: By reviewing and auditing your claims carefully, you can spot possible problems and fix them before submission.
Medusind: An all-in-one solution
If all this extra work sounds like an unnecessary burden, it is. Your staff is already overworked—is it necessary for them to subtract more time from patient care and devote it instead to navigating a bewildering bureaucratic maze?
Medical revenue cycle management (RCM) is a complex and tangled process. Fortunately, Medisund is a national leader in medical billing and collection, with over 20 years of experience in this specialized field. We’re experts in overcoming medical billing problems.
Would you be interested in a 25% improvement in your collection rate and a 40% improvement in the time your claims spend in A/R? If so, contact us, and we can demonstrate how we can dramatically upgrade your RCM to maximize your profitability by solving your medical billing problems.
