6 Medical Billing Issues that are Affecting Your Practice Revenue

Touseef Riaz

November 26, 2020


If you run or manage a medical practice, you know that avoiding all medical billing issues and errors might be impossible. This is especially true in busy offices where details, such as a patient’s date of birth, may get lost in the shuffle. However, note that if you focus on preventing the most prevalent medical billing issues, you may be able to make the most of your staff’s time, maximizing practice revenue in the process.

You may know that one of the major challenges faced by doctors and physicians nowadays is not solely concerned with quality patient care; rather, many healthcare providers today are highly concerned about the business aspect of healthcare, particularly with respect to medical billing.

There is no doubt that medical billing is usually fraught with difficulty. From sloppy procedures and miscommunication to exasperating guidelines from different payers, billing errors and issues can really add up and put a dent in your revenue. You know that errors in medical billing can cause payment delays, complaints, rejection of claims, and even loss of productivity. And you don’t want that.

If you run a medical practice in this competitive environment, you know that the financial health of your practice is usually challenged because of more scrutiny over coding practices and shrinking reimbursements. Did you know that common billing issues and errors can lead to claim denials? This is regardless of the specialty or size of your clinic, practice, or hospital.

While there is no doubt that medical billing errors usually arise from minor mistakes, note that these common billing errors can quickly add up to considerable lost revenue, especially in the long run. It is no secret that any medical practice relies on its medical billing to generate revenue streams from the various services it renders.

Keep in mind that medical billing issues and challenges can inhibit your practice’s ability to collect the money owed, hampering your practice’s ability to grow. If you understand these medical billing issues, it can help your practice solve them before they can affect your revenue.

1. Failure to Follow Up on claims

Did you know that many medical offices in the country fail to follow up on outstanding insurance claims? As you can imagine, these practices can leave a considerable sum of money behind. Medical billing professionals have to make follow-up calls in order to check on the status of the payment.

There is no doubt that an effective and efficient insurance model can help healthcare organizations, such as clinics, recover overdue payments from various insurance carriers. And this is when accounts receivable follow-up comes into the picture. Note that checking insurance claims must be a continuous process. Your staff has to proactively monitor aging reports in order to identify ignored claims.

2. Inaccurate or Incomplete Patient Information on File

You probably know that if a patient’s correct personal information and insurance information aren’t on file, it will likely result in claim denials. And this can make it more challenging for your medical practice to collect any money that a patient owes you. It is worth noting that a misspelled name, an incorrect subscriber number, or a wrong date of birth may seem like minor mistakes, but they can wreak havoc on your practice’s revenue cycle.

Keep in mind that these mistakes can occur for many reasons, such as a patient’s sloppy or illegible handwriting to an office staff who is distracted while inputting the data. Did you know that having patients complete forms online will help increase accuracy? Also, staff members in your office responsible for billing should have undistracted time in order to complete all their duties.

Also, your practice should ask all the right questions. This will help you collect all the needed patient information. Note that after collecting this information, it must be verified and input into your medical billing system in a timely manner.

3. Not Filing Claims on Time

It is no secret that many third-party payers can have different timelines. This is why many practices fail to maintain the cycle of awareness. They also do not spread information regarding the deadlines that are usually subject to claim denials, which can be problematic.

At times, paperwork tends to get lost in the fray. And by the time you discover oversight, it’s beyond your insurance payer’s deadline. As a result, the practice has to either eat the cost or risk angering its patients. So, keep in mind that if your billing staff fails to keep track of all the deadlines different insurance payers observe, then your medical office will waste time filing medical claims that are destined for denial.

Did you know that in a few cases, previous medical claim denials caused because of other errors might fall into this category of untimely filed medical claims as well? It is worth noting that these third-party payers will still reject the claims. This is because the re-submission doesn’t fall within the timely filing limit.

4. Inaccurate Coding

Few can argue that inaccurate coding is still one of the top medical billing issues for many practices. This might be true even if your medical practice made it through the ICD-10 implementation successfully. You may know that inaccurate coding happens for many different reasons. For example, the one hand, medical codes are always changing. This is why even the most seasoned and educated coders usually make errors unwittingly.

Here is another reason; coding entails inputting several strings of numbers repeatedly. So, it is inevitable that an error or mistake will happen somewhere along the way. And that is not all; note that recent changes in both medical billing as well as diagnostic coding systems may place an additional burden on a small practice.

Keep in mind that inexperienced office staff may not recognize suitable codes or coding patterns, and this can eventually lead to claim denials. Here are some common mistakes:

  • Making a mistake in the modifiers
  • Putting in treatment codes and diagnostic codes that are mismatched
  • Insufficiently documenting components, grafting materials, and devices
  • Entering too few or too many digits for ICD-10 codes
  • Missing or poor documentation
  • Minor errors or mistakes in patient information
  • Downloading, which means coding at a lower level compared to the service or level supported by medical documentation

To avoid these mistakes, you should ensure that your clinical staff is properly trained on the latest ICD-10 coding updates. You should also continue to educate your coders, ensuring your staff communicates with clinicians whenever documentation issues or problems occur.

5. Inefficient or Manual Claims Management Processes

It is no secret that filing insurance claims is often a complicated process, and it is constantly evolving. This is why if your practice relies on an inefficient or manual claims management process, it will likely result in considerably more denied claims. It will also waste staff time. Did you know that inefficient processes often involve outdated automated systems or manual medical billing?

Managing coding and billing can be complex and time-consuming for any medical practice. However, note that many practices are still using manual claims management processes in order to deal with claims denials. Your practice can benefit from having an automated and efficient denial management process.

Also, note that you can make your claims management processes more efficient and effective by outsourcing or using medical billing software. This is why automating the medical billing as well as claims management process in your organization, will help providers retrieve reimbursements from denials and rejections in a timelier and more efficient manner.

6. Not Informing Patients of their Financial Responsibility

When it comes to billing, keeping all your patients informed and educated can be a challenge.While medical billing aims to collect the whole amount for various medical services that you have provided, note that many practices have a tough time collecting payments timely from their patients. This is because of the significant increase in patients’ financial responsibility.

Did you know that most consumers are simply not aware of the true magnitude of their financial responsibility? And this can make it harder for medical offices to collect the payment for services rendered.

So, if you would like to boost patient revenue, your organization should implement strict financial policies that include informing patients about their financial responsibility, estimating the costs of services, and collecting some of the amounts during a visit.

Also, it is worth noting that taking measures in order to simplify and streamline bills for patients may also help your practice collect more. This is because many patients often find that their medical bills are a rather confusing mix of medical jargon and multiple payment requests.

According to research, when patients know more about their bills (such as balance, payment options, and methods), they are more likely to pay. Note that EHR, quality practice management software and billing software will help you achieve this more effectively.

You could also overcome this issue by working with a professional medical billing firm. Did you know that medical billing specialists implement policies that make it simpler for patients to pay for medical services rendered in a timely manner?

Final Thoughts

By maintaining a proactive and updated medical billing practice, you can operate at top potential while eliminating costly errors that inhibit your ability to offer the best care to your patients. One of the best ways of resolving your medical billing issues is to work with the best billing professionals, such as UControlBilling. If you are looking for ways to boost medical practice revenue, UControlBilling can help.

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