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by Plutus Health

September 13, 2021

Top 6 Medical Billing Challenges Facing Providers Today

by Plutus Health
Plutus Health Inc

Medical billing can be demanding and time consuming, often resulting in roadblocks. For example, over 50% of primary care offices say that they’re overwhelmed with  updates to medical billing procedures and making changes for new patients’ requests.

Since confusion over insurance obligations is widespread,challenging a medical bill is common. In addition, these patients often are from low-income families and already might have problems with medical bills in their history. While billing companies can significantly increase the amount paid and faster payments, providers should be aware of common billing pitfalls. 

Here are some of the greatest challenges in medical billing facing providers today.

Filing Multiple Claims

Depending on your medical specialty, you may have to file thousands of claims a week. This workload often entails filing each one personally since some billers lack the technology to process multiple claims at once. The lack of a mass filing option, creates holdups and slows the billing process considerably. 

Increasing Demands for Information

The Covid-19 crisis demonstrated the importance of detailed patient data for insurance providers. As such, many insurance companies have increased their standards for what they expect to know about a patient’s condition and corresponding procedure. Unfortunately, these additional requirements cause slowdowns on coders and billers who are unable to proceed without precise clinical documentation. 

High Training Requirements

An effective medical coder will need to know crucial electronic systems such as EMR and EHR. These systems provide digital documentation for a patient’s medical records. EMR can only access information from a single provider, whereas EHR can access information from multiple providers. Some programs such as Medicaid require EHR before giving incentive payments.

Both EHR and EMR require significant amounts of training to operate. The efficiency of third-party support also limits its effectiveness. 

Medical coders and billers must also renew their professional credentials every two years. This renewal can be study intensive since shifting regulations require them to re-familiarize themselves with the latest updates.

Coding Errors

Though a significant portion of coding is going digital with computer-assisted-coding(CAC), human coders still make up a large percent of the workforce. As such,errors such as typos frequently lead to claim denials.  These errors are more frequent when coding in an environment of changing regulations. And Covid-19 has caused a new set of coding challenges with significant changes.

New Technological Advancements

Covid-19 created a perfect environment to push computer-assisted coding (CAC). These systems can scan through patients’ clinical records to determine the appropriate codes. As a result, computer-assisted coding is faster than its human counterpart.

However, companies keep programmers on staff to observe the CAC’s functionality and accuracy. While seemingly easier than previous versions,these updates are new to many coders and require keen observation, taking up a considerable amount of time.

Confidentiality Laws

Privacy is critical in medical billing and coding, and laws such as HIPPA have been created to protect personal health information.Unfortunately, following these rules and being compliant requires a significant amount of time and effort. 

Like any other regulation, HIPPA and most privacy laws are subject to change. Therefore, medical billers and coders must pay attention to these changes to avoid heavy penalties. 

PlutusHealth Incorporated works with you to streamline medical billing if you are struggling with billing, collection and management; our expert team of medical billers takes care to get the fastest reimbursement possible and increase your practice’s performance.

Key Takeaways

1. Billers that lack technology may have numerous claims to file.

2. Information requirements have increased.

3. Training is extensive to handle new technology and updated codes.

4. Human error still causes significant holdups. 

5. New technology requires specialized knowledge and observation.

6. Confidentiality laws need careful attention to detail.

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