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November 21, 2022

Unique Challenges of Physician Medical Billing

Thomas John has 25+ years of experience in healthcare RCM and IT. He is the founder and CEO of Plutus Health Inc., one of the biggest healthcare RCM companies in the US. Thomas has comprehensive knowledge of AI-driven practice management and billing software. He believes in providing an end-to-end solution for revenue cycle and practice management.

ABA Providers Recover Dues From Patients To Efficient Your Account Receivables

Physician medical billing is more complicated than it seems. A continuous shift in regulations and procedures for healthcare leads to heavy revenue losses resulting in some physicians experiencing financial crises. Healthcare providers lose around $125 billion annually due to medical billing errors. To sustain and be able to compete, physicians must be thorough with some of their core processes like patient engagement, satisfaction, billing, and payment collection.

Even if the physician has submitted claims after taking due precautions and the utmost care, there is a high chance that claims will be rejected or denied. Around 200 million claims are denied annually due to process or billing errors that can be easily avoided. New government regulations, globalization impact, rising healthcare costs, and technological advancement are a few contributors that affect physician medical billing. Plutus Health has put together and tracks a complete list of unique challenges of physician medical billing. Knowing the challenges helps physicians proactively prepare and combat medical billing difficulties. This generates additional revenue for healthcare providers.

Administrative Load

Physicians deal with abundant work stress due to the nature of their work. They must be keep up with constantly changing rules to stay compliant. Administrative and medical billing tasks, along with patient care, add more load to this already present and ongoing stress. If providers are too stressed or bogged down by the ever-changing rules and administrative burdens, then this will negatively patient care, documentation, or both.

Offering premium care to patients is not enough to ensure the reimbursements required to sustain a provider’s business in this constantly changing healthcare industry. The administrative load can be easily minimized by assigning a dedicated team for office and medical billing tasks. These experienced professionals can handle all the administrative tasks and free-up physicians to focus more on patient care.

Breach of privacy and data security

Cyber-attacks, frauds, or data breaches happen in all industries, but these attacks are very severe in healthcare because highly sensitive data is involved. Hackers use advanced technology to get patient data, physicians' billing information, and revenue details, leading to privacy and security breaches. Over 249 million individuals were affected due to breaches in healthcare data.

Generating revenue and providing excellent patient care is highly dependent on sensitive data; hence physicians should take extra care to add more security to prevent a data breach. Adding a firewall or using cloud technology would prevent data and prevent losses from these cyber-attacks.

Always changing laws

HIPPA laws were created to protect patients' data and privacy, and physicians must follow them. These laws bring patients, providers, and payers to common ground so that all the processes get streamlined. But the confidentiality of these laws keep changing, and failure to comply with these changes results in a heavy penalty to the physicians.

Increased denials

Payment rejection or claim denial are the most prominent billing challenge for physicians. Physicians are always busy with patients, leaving them no time to address claims, resulting in payment denials. Changing patient demands and regulations add to claim denials. A minor billing or coding error results in claim denials, which then causes financial instability for physicians. According to a recent report, $262 billion worth of claims were denied, out of which 65% of the denied claims were never resubmitted.

Physicians should plan to deal with billing issues and denials to prevent revenue loss. They can leverage practice management software like Artemis or partner with RCM service providers who can seamlessly manage their medical billing and denials.

Specialty billing procedure

To gain maximum benefit from the submitted claims, physicians or those responsible for their medical billing should know all the changes in laws and regulations. Billing procedures are different per specialty, and physicians should be well-versed in special handling, specialty billing, and authorizations. A focused and specialized billing procedure demands the appropriate knowledge to obtain faster reimbursement and streamline the process.

All the physicians need to gain the knowledge or time to dive into the process details or keep up with the changes. Absence of knowledge, results in errors that cause an unnecessary spike in rejections and denials.

Inconvenient or outdated EHR interface

Technological upgrades in the healthcare industry and modern EHRs have great potential to improve outcomes and patient care. The patient's registration should be altered due to the new CMS requirements, which have made some EHR interfaces obsolete. Physician billing services gets negatively affected if the doctors do not use the latest efficient and effective software solution for medical billing and patient registration. Dividing time between computers and patients adds difficulties in patient billing.

Solutions to Challenges of Physician Medical Billing

Medical billing challenges faced by physicians impacts their cash inflow. To fight these challenges, outsource your medical coding and billing services to a tech-enabled RCM provider like Plutus Health would show great results. Our team's physician billing and coding experts provide end-to-end services to healthcare providers, giving them plenty of time to serve their patients without bothering with medical billing challenges. Connect with Plutus Health's medical billing and coding specialists today, and start growth in your practice and higher cashflow.

Key Takeaways

  • HIPPA laws keep changing, and physicians who fail to make changes lose revenue.
  • Denials negatively impact the revenue of healthcare providers, and proper management of the medical billing processes is the best way to increase revenue.
  • EHR software plays a significant role in physician billing.
  • Data protection is vital in physician billing as the data consists of sensitive patient information and billing details.

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Thomas John, CEO of Plutus Health

Thomas John has 25+ years of experience in healthcare RCM and IT. He is the founder and CEO of Plutus Health Inc., one of the biggest healthcare RCM companies in the US. Thomas has comprehensive knowledge of AI-driven practice management and billing software. He believes in providing an end-to-end solution for revenue cycle and practice management.