The Executive Suite: Challenges physicians usually face with the medical billing processes

The shifting procedures and regulations in the medical billing processes in the healthcare industry has led to scores of physicians undergoing financial crises. However, when you know what the challenges are, it becomes easy to tackle them, right? Let’s glance through the common and real-time challenges faced by the physicians with the medical billing processes, shall we?

Specialty billing process: if you want to reap the benefits of the medical practices, it is crucial to stay afloat with the changes which take place. Medical specialty specific billing requires special handling, authorization and pre-certification to carry out the complex tasks. Such specialized and focused medical billing processes also require knowledge, to streamline the process and gain faster reimbursements. However, not all physicians have that much amount of time and knowledge to keep up with the changes and dive in-depth with the detailed process. Absence of knowledge leads to nothing but errors in claims, resulting in denials.

Changing confidentiality laws: HIPAA Laws have been created to protect the privacy and data of the patients, which needs to be adhered to by the healthcare settings. However, these confidentiality laws are subject to constant change which leads to heavy penalties in case not met properly. Physicians fail to keep a track of the changing confidentiality laws which loops them in deep-trouble.

Coding errors: As per the Becker’s Hospital Review, 80% of the medical bills have errors. Medical settings are making a shift towards computer-assisted-coding ; however, there is still scope for humans to make errors. Such typos lead to the claim denials. Thus, it is advised to the physicians to onboard people with years of expertise or simply outsource the medical billing process.

Poor employee training: The understanding of the digital documentation is very significant for a medical coder to ensure a smooth billing process. However, a lot of medical settings fail to renew their professional credentials and train their staff with the latest updates, which creates a loophole in the entire medical billing system.

Poor tracking claims: This is one of the most faced challenges by the physicians in the medical billing processes. The revenue management cycle requires the claims to be tracked through its complete lifecycle, thus the medical coders and billers need to pinpoint the errors. In case these errors are not resolved rapidly, it leads to loss in revenue.

Complicated revenue collection process: To gauge an understanding of the new coverage policy, the payers require an ample amount of time. This leads to confusion, resulting in denial of claims due to minor errors, complicating the entire process for the medical billing system.

Administrative load: As per the Cincinnati Enquirer, over 411,000 seniors have faced double-billing for their medical billing. This happens because physicians undergo a lot of stress in the medical settings due to the nature of the profession they have. Apart from taking care of patients, they need to play a role in the administrative duties, which just adds to the bucketload of stress. It is not easy to ensure smooth patient care along with the documentation process, because the latter demands staying abreast of the changes which take place in the system and being constantly up to date.

Absence of technological advancements: Scores of physicians’ medical settings have manual processes which leads to extension of time. Due to the absence of technological advancements, healthcare providers are not able to provide accurate and rapid response to the patients.

Information gaps: A lot of medical practices carry out the crucial information by hand which automatically results in errors, this leads to the claims getting denied even if there is a tiny mistake.

Lawsuit related challenges: There is a constant stress to complete the documentation in the correct manner else the physicians are liable to lawsuits. However, this just adds up to the additional task list that the physicians need to perform, distracting them from patient- care.

Data security and breach of privacy: In no small measure, cyber-attacks happen in every industry and the healthcare industry is no such exception to this. Hackers have advanced technologies which may put your patient data at risk and you're breaching their privacy. Thus, to ensure patient information confidentiality, physicians must have secured firewalls to protect their system.

With the advancement of advanced technologies, the healthcare sector has skyrocketed in terms of their medical billing processes. As per the Research and Markets, the medical billing outsourcing market value will hit $8 million by 2026. However, there are still scores of physicians’ medical settings which use the traditional hand-written method for their medical billing processes. The former has led to decrease in valuable time used, administrative errors and costing. In no small measure, these advanced technologies have facilitated a simple experience and boosted patient engagement rate. Thus, if you’re battling these challenges related to medical billing processes, the best option is to outsource it to a medical billing company.