Medical billing is the cornerstone of the healthcare industry, and when problems arise, it can impact every party involved.
If you run or own a medical practice, you know how crucial it is to implement an efficient and effective medical billing process. Let’s take a closer look at the top 7 medical billing challenges that practices face, and how to solve them.
1. Missing or inaccurate patient information
The most common medical billing challenge is either inputting incorrect patient information or not having the right information. Every character counts when you input a patient’s information into your billing system. Even the most minor data inaccuracy can cause a major headache! A misspelled name or wrong date of birth may not seem like a big deal, but it can drastically impact your practice’s revenue.
There are a few easy ways to prevent this common mistake from happening:
- Double-check every entry to ensure that there are no errors. If something seems suspicious, ask for clarification.
- Have the patients enter their own information and confirm it before the appointment.
- Use a practice management software that automatically fills in the patient data based on their verified information
2. Missing documentation
As you double-check for missing patient information, you may come across some missing documentation as well.
Insurance companies require specific information to pay claims. If the necessary documentation is missing, the insurance companies will not hesitate to deny the claim. To overcome this challenge, ensure that your staff is properly trained on how to submit claims. You should also integrate a medical billing software into your practice that streamlines the claim submittal process and makes attaching the right documents easier.
3. Filing claims too late
Not filing claims on time is a massive problem for your medical practice’s bottom line. 3rd party payers can have different timelines for filing a claim, so it’s important to document the deadlines accordingly to avoid this issue.
Practice management and organization is key here. You risk eating the cost if the paperwork is not submitted by the insurance payer’s deadline.
4. Using incorrect codes
One of the most common challenges in medical billing is coding medical claims. Claims can be coded improperly for many reasons, including:
- Underbilling
- Using outdated code books
- Missing a code
- Missing documentation
- Mistakes in patient information
Codes change every year or even sooner. Each insurance provider accepts different codes for billable services and updates whether they accept them or not, along with rates provided for said codes. It’s crucial to stay updated with each insurance provider’s medical necessity criteria and their acceptance of coding with the criteria associated with said codes.
5. Insurance claim denials and rejections
Nearly 20% of all claims are denied, and more than 60% of those claims are never resubmitted. When a claim gets rejected, it’s important to investigate why.
Claims can be rejected for a number of reasons like inaccurate patient information such as misspelled names or incorrect policy numbers. Does your practice have a high denial rate due to missing documentation or inaccurate patient information? If so, your claim submittal or check-in processes may need to be reviewed and updated. When you get to the root cause of the claim denial, your staff can work to correct the error swiftly.
6. Missing referral or authorization
Patients are often required to get a referral from their primary care doctor before being able to receive certain healthcare services. Without a referral or authorization, the insurance companies can deny a claim.
In this situation, you must ensure that you confirm a referral with the patient. If there is no referral in place, you can direct the patient on how to obtain the proper referral so you can submit the claim worry-free.
7. Working with limited technology
Technology is advancing every day, and working with outdated technology can severely limit the success of your practice. If your technology can’t keep up with the ever-changing healthcare industry, your practice won’t be able to keep up with the competition.
An efficient medical billing process requires extensive organization and a high attention to detail. Even the smallest mistake can hurt your bottom line! To learn more about how Mosaic Medical Billing can streamline your medical billing processes and help drive revenue, get in touch with our team.
