The United States of America is the third most populated country in the world. With over 346 million people, there is a high demand for healthcare experts in various medical fields, including medical billing and coding. On average, medical records specialists are required to fill 15,000 job vacancies annually during the next 10 years.
However, there is a growing shift in complexity in the healthcare environment. Many healthcare providers and practices are outsourcing medical billing to optimize revenue cycle management (RCM) while focusing on core healthcare functions. In 2023, Grand View Research estimated the medical coding market to be at $36.30 billion. It further projects the market to expand at a compound annual growth rate (CAGR) of 10.22% between the forecast period 2024-2030.
However, our blog covers a few of these billing challenges that coders and billers encounter during the reimbursement process.
What is Medical Billing & Coding?
As a healthcare practitioner, you must have heard about these terms, medical billing and coding. But what does it mean? Are these two terms interrelated? Here is an answer to your queries. Medical billing is simply a process of submitting claims for the services a healthcare provider has provided to patients. This process has various steps, such as collecting patient data, including treatment records and associated insurance information, and filing error-free medical claims.
However, medical coding is a part of medical billing. There is a code for each medical procedure, diagnosis, and item (equipment, device, or drug). A medical coder is a professional who converts the services of a healthcare provider into CPT codes. For example, if a doctor has prescribed a particular medication or a doctor’s diagnosis, the professional coder will be in charge of converting this process into an alphanumeric or numeric code.
Challenges of Medical Billing & Coding
Medical billing and coding are crucial elements of the revenue cycle, particularly for independent practitioners and clinics. Small practices typically do not have the in-house personnel or technical capabilities to handle these operations efficiently. That’s where companies offering medical billing services for small practices can add value by streamlining billing, eliminating errors, and increasing cash flow without overburdening clinical staff. The following section provides a discussion on some of the most common challenges faced by healthcare providers and their billing teams during the reimbursement process.
Errors in Documents
Missing or incomplete documentation is the biggest challenge in medical billing and coding. For example, insufficient or missing data in patient records. Medical coders find it difficult to translate patient care into the proper alphanumeric codes if there are missing details regarding treatments, imprecise terminology, or incomplete physician notes.
On the other hand, certain medical practitioners carry out the documentation by hand, which usually results in a lack of transparency and more human errors. Even a minor error or missing patient data can result in claim denials.
Over/Under Coding
Over/Undercoding are two terms that can have serious implications on your reimbursements. Let’s break down both terms one by one.
Over-coding is assigning codes that exaggerate the complexity of the services offered. On the other hand, under-coding occurs when codes fail to capture all of the work done by a provider.
Both may result in possible fines and penalties. However, the only way to avoid these is to examine the documentation thoroughly, ask providers for clarification when necessary, or speak with managers and auditors.
Delayed Reimbursement
There may be multiple reasons for reimbursement delays, including improper coding or documentation mistakes such as misspelled names, incorrect addresses, or inaccurate insurance information. Additionally, insurance companies can also cause delays due to the need for more information, or disagreements on coverage are a few examples.
However, billers and coders can avoid these problems faster by being aware of insurance policies and keeping lines of communication open with insurers.
Compliance with Regulations
The ever-changing norms and regulations in the medical industry make medical coding more challenging. If the medical coder ignores or misses out on any recent update, it may cause claim denial or sometimes heavy fines from the regulatory bodies.
To prevent this, they must become familiar with the guidelines, stay updated on revised ICD, CPT, and HCPCS codes, and consistently follow the rules. There are RCM experts who provide current experience and tailored solutions to help providers comply with payer laws, government regulations, and coding modifications.
Latest Technologies
Technology has changed the whole process of Medical billing. It used to be done using paper-based methods and handwritten records, but with the advent of different technologies in the healthcare industry, the process has been transformed into an electronic one. This transformation has led to time and cost savings, as well as a reduction in human and administrative errors.
One Way to Overcome Challenges
We understand how difficult it may be for medical professionals to treat patients and deliver them high-quality services while handling these medical billing issues. Outsourcing billing to one of the best healthcare revenue cycle management companies in your state or local area is the most effective way to overcome these difficulties.
Outsourcing can help you get your hands on the best billing and credentialing experts on and offshore because these third-party companies invest heavily in training their employees to overcome specialty-specific billing and coding challenges. They guarantee and help you achieve outcomes with fewer mistakes, reduced denial rates, and quicker and more precise reimbursement. Some coding and billing companies implement billing software or automation technologies, which enhance quality and expedite procedures. Increased efficiency and reduced expenses follow, which they subsequently transfer to their clients as value addition.
Small Healthcare practices must outsource to a leading medical billing service provider since it increases efficiency, reduces expenses, and eases access to specialized services for value addition.
Conclusion
Evolving patient expectations, complex regulations, and the rapid adoption of AI in insurance billing are making it harder for medical professionals to manage their coding and billing workflow. Outsourcing is, therefore, their sole option for overcoming these obstacles. Companies that offer medical billing services also need to invest in the training of their coders and billers to keep up with the most recent industry trends, billing compliance requirements, and government regulations.
