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6 Challenges of Medical Billing Practices

medical billing practice

6 Challenges of Medical Billing Practices

Revenue cycle management is dependent on efficient medical billing practice and it becomes quite challenging for the healthcare staff to cope with the pressure of maintaining accuracy. The pressure increases with the number of patients making the use of revenue management software mandatory. Here are the top challenges in medical practices faced by most of the healthcare professionals.

  1. Claims management

This is one of the most common challenges in medical billing protocols. Claims management is a complicated process and many claims get rejected due to several factors like incorrect coding, eligibility failures, lost data, missed deadlines, etc. Due to this, many organizations do a poor job of claim resubmissions. Good medical revenue management processes and tools ensure all of the claims are submitted and managed in a way to optimize practice collection rate.

  1. Outstanding Accounts Receivable delays

A lot of customers also complain about the delay or not getting their outstanding Accounts Receivable (AR). This not only tarnishes the reputation of the healthcare organization but also leads to further cost spending including outsourcing the credit collection through a third-party billing service. Do away with bad debts or AR with a solution that reviews these charges and assures outstanding accounts receivable within a short span of time.

  1. Maintaining patient data

Keeping a record of all the patients and protecting their information consistently is equally challenging. Besides, it is mandatory to adhere to HIPAA which includes protection of patient data. The healthcare organization needs to review and verify the patient information and keep track of the payment infrastructure per the mandates of HIPAA and PCI to avoid future penalties.

  1. Patient communication

Patients often complain about lack of proper communication between the healthcare unit and them. It becomes difficult to inform and update them about their insurance claims on time. With the help of an efficient revenue management system, the healthcare organizations can automatically verify the insurance coverage. This not only streamlines customer communication but also prevents billing slip-ups.

  1. Coding updates

While operating the medical billing system, the staff needs to incorporate specific codes for service continuity. These codes are frequently updated making it difficult to cope with the changes. The billing system must have the provision to review these changes and optimize the revenue management accordingly.

  1. Huge expenditure

Every year, top dollars are spent by the healthcare sector to systematically incorporate revenue distribution and streamline their administrative burden. However, administrative glitches could not be avoided due to an outdated medical billing system. The healthcare organizations should, therefore, make sure the revenue management system is well equipped with updated features.

How to curb these challenges in pediatric practices?

Collect more than 99% of reimbursable claims; maintain an average of less than 25 days outstanding Accounts Receivable (A/R); reduce your administrative burden while improving your operations, and improve Customer Service for patients with Pediatric Xpress.

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