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Medical Billing Challenges and How To Avoid Them

Medical billing is an integral part of your practice's financial well-being and a successful process requires more than just dedication. Unfortunately, medical billers can face many common challenges that could have far-reaching effects on the operation. But don't worry - with awareness of these potential issues, you'll be able to prepare for them in advance so they won’t affect your business operations!


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Here are six usual impediments that come up during medical billing procedures – along with simple steps for preventing each one.


Building A Qualified Medical Billing Team

Building a qualified medical billing team can present certain challenges depending on the size of your practice. Documenting medical codes, managing secure files, and interacting with insurance companies require medical billers to have specific training and a keen attention to detail. To effectively have your medical billing staff members trained and prepared for their roles, medical offices need to take the time to ensure that prospective candidates have the knowledge and qualifications for success. Training resources should be made available, such as programs offered at medical colleges or dedicated medical billing courses. Given continual changes in medical industry regulations, it's also imperative that medical billing teams are consistently encouraged to stay up-to-date on relevant news and updates in medical coding.


Perhaps your office is not equipped to handle medical billing in-house. Entrusting your practice's needs to a trusted, certified service provider could be a solution. When you hire an experienced & reputable team, you can rest assured that your business is represented by qualified professionals with years of knowledge and credibility.


Keeping Patient Information Up to Date

Keeping medical records and patient information up to date presents many challenges for healthcare professionals. First, medical records often get manually passed between multiple medical providers, leading to potential errors due to written miscommunication or lost information. Additionally, staff turnover and a lack of time can lead to medical mistakes resulting from incorrect entries in medical billing and electronic medical records. However, there are also solutions to these challenges; dedicated medical staff can be trained in the most current best practices for medical record keeping, from maintaining accurate written records to working with electronic comprehensive medical systems. By implementing organized processes for medical data handling and transitioning the implementation of updated technology into day-to-day operations, healthcare teams can effectively keep patient information up to date while minimizing the risk of errors.


Inaccurate Coding and Documentation

Accurate medical coding and documentation are critical components of medical billing. It ensures healthcare providers receive fair reimbursement from payers for medical services rendered. Despite the importance of accurate coding and documentation, errors can occur due to manual data entry, unspecific medical abbreviations or codes, wrong selection of diagnosis codes, or using an outdated code set. To alleviate accuracy issues, medical practices can implement automated recordkeeping systems that help decrease human errors related to medical billing. Additionally, practices should conduct regular staff training and code audits to identify potential inaccuracies so corrections can be completed right away. By instituting these safeguards, medical providers will experience fewer inaccuracies in patient records as well as reduced write-offs or denials due to incorrect coding and documentation.


Differing Billing Requirements

Medical billing can be a complicated and intimidating process for medical professionals. Different medical services each require different billing procedures, making it difficult for medical providers to stay up to date on the necessary requirements. Without clarity in medical billing processes, medical providers may be more susceptible to fraud or administrative costs due to errors. To prevent these issues, medical providers should take time to research the necessary procedure for each service prior to billing in order to ensure accuracy and compliance. Educating medical staff on best practices regarding medical billing as well as staying current on changes in regulations are critical steps in mitigating the challenge of different billing requirements. Additionally, organizations seeking help with these compliance challenges can turn to certified medical billers who have expertise in specific medical billing codes, payment processing, documentation requirements, and other relevant regulations.


Tracking and Resubmitting Denials

One of the many challenges medical billing departments must contend with are denials from payers for various reasons. The process of tracking, analyzing, and resubmitting denials can be complex and time-consuming. Fortunately, there are a number of solutions available for medical practitioners to streamline this process. Automated tracking tools allow medical billing teams to monitor response times from payers, review payment histories quickly and ensure that claims are in compliance with all relevant rules and regulations. Utilizing these tools as part of their medical billing practices can help medical providers identify issues more quickly, reduce administrative costs, increase efficiency and maximize reimbursement opportunities.


Collecting Patient Balances

Collecting patient balances can present medical billing professionals with a plethora of challenges. With growing medical costs, patients are often unable to pay for medical services due to insurmountable medical bills. Lack of medical insurance, rising deductibles, and co-insurance have placed a financial burden on many medical consumers. Even with assistance from charity organizations or payment plans, collecting patient balances remains an issue for medical billing professionals. The best solution for collecting patient balances is an effective follow-up process that is consistent, yet flexible enough to address the individual needs of each patient. This customized approach should also include clear communication regarding bill expectations and payment options without pushing away valuable customers. Developing systems that monitor follow-ups while providing generous payment opportunities may prove lucrative in solving this particular challenge related to medical billing and collection issues.


Patient billing is a dynamic and critical process for any successful healthcare organization. Medical billing challenges can cause significant stress for providers and staff, but with the right medical billing team in place, these difficulties can be mitigated. If you are having trouble keeping up with patient information or submissions, consider outsourcing your medical billing to a reputable company. At The Billing Department, we have years of experience working with different insurance companies and understanding their specific coding and documentation requirements. We can help take the burden off you and your staff so that you can focus on providing quality care to your patients. Contact us today to learn more about how we can help streamline your medical billing process.




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