Physician Billing Services: The Prominent Challenges and The Tips to Overcome Them

In the healthcare industry, the procedures and regulations in the medical billing process keep shifting constantly. This leads to financial crises within healthcare organizations. Various challenges arise daily for physicians and the first step towards overcoming them is to know what the challenges are.  

Let’s get into the intricacies of Physician Billing Services and the ways to tackle them effectively. 

The Prominent Challenges in Physician Billing includes: 

Staying Updated with the Changes and Advancements 

If you want to reap the benefits of a smooth revenue cycle and timely submission of medical claims, it is important to stay updated with the changes. Physician billing services demand special handling, authorization, and pre-certification to carry out the most complex tasks. When the processes are focused, it requires knowledge, to streamline the billing and gain faster reimbursements. 

However, the main struggle here is that not all physicians have the time and knowledge to dive deep into the intricacies and keep up with the changes. The absence of knowledge and updates leads to claim denials and lowers the pace of reimbursements.  

Ever-evolving Specialty Laws  

To protect the privacy and data of patients in healthcare, HIPAA Laws have been created. These HIPAA laws need to be adhered to by the healthcare settings. One thing that needs to be considered in the case of these confidentiality laws is that they are subject to constant changes. This leads to heavy penalties in case the laws are not met properly.  

Physicians have a lot of primary tasks on their table that demand their undivided attention. Because of this scenario, they fail to keep track of the changing confidentiality laws and regulations which puts them in deep trouble and hampers their reimbursements. 

Errors in Coding  

According to a review of Becker’s Hospital, 80% of the medical bills have errors. As there are complex codes involved, the possibility of errors increases automatically. These errors are a reason why medical professionals and healthcare providers are making a shift towards computer-based coding. But the scope of human errors can still not be eliminated completely. These typos are the reason for claim denials.  

Therefore, it is advisable for the physicians to get professional help in medical billing by simply outsourcing the entire procedure.  

Poor Training of Employees 

It is very significant for a medical coder or biller to have a deep understanding of medical billing processes. During the complete lifecycle of a claim, it should be tracked properly in the entire process. Therefore, the medical coders and billers need to pinpoint the errors that arise along the way. In case these errors are not resolved quickly, a loss in revenue is inevitable. 

Complicated Process of Revenue Collection 

Another critical challenge in revenue cycle management is to collect payments from the patients. With the rise in out-of-pocket expenses of patients and higher deductibles, it is quite a struggle for many patients to afford immediate payment for medical services provided to them. Healthcare organizations face the task of balancing debt collection daily. Providers must develop a proper understanding of patient responsibility. Streamlined methods must be implemented for collecting payments to maintain financial stability within the healthcare practices. 

The best option for physicians would be to choose a medical billing partner like Eminence RCM and hand over the complicated process of payment collection to the experts.  

Adds Up to the Administrative Load  

The healthcare world is set up in such a way that physicians undergo a lot of stress because of the nature of the profession they have. Apart from taking care of patients, physicians need to play a role in the administrative duties. It just adds to the bucketload of stress for them. It is not possible to ensure smooth patient care along with the documentation process, because the latter requires staying constantly in touch with the changes that take place in the entire process.  

Breach of Privacy and Threat to Data Security 

With the world moving towards digitization, cyber-attacks are inevitable in every industry. The healthcare industry is no different. Hackers have advanced technologies that may put valuable patient data at risk and their privacy will be at stake. Thus, to ensure the confidentiality of patient information, physicians must have secured firewalls to protect their information and systems.  

If you are battling with the challenges of data privacy and security of patient information, the best way is to choose a reliable medical billing partner.  

Let’s Discuss the Tips to Overcome the Challenges of Physician Billing: 

Ensuring Transparency in the Process 

One of the easiest ways to improve your billing process is by ensuring transparency regarding the payment process with your patients. You can do it either by communicating it to them directly or by including details in the patient information form. Many physicians put signs in the reception area to ensure that the patients don’t make any mistakes while making payments for the diagnosis or treatment provided.   

Training Programs for Employees 

It is not an easy task to deal with different insurance companies and ensure timely reimbursements. Every insurance provider has its own set of protocols that have to be followed with scrutiny. Therefore, upskilling the staff becomes necessary as it will not only ensure improved knowledge but also will make them more efficient in handling different payers.  

Ensuring the Patient’s Files are Updated 
The patient’s information keeps on changing with time. A patient who visited you a year ago might have changed the insurer or purchased a new healthcare policy. To ensure an efficient and accurate medical billing process all these things should be properly taken care of. You, as a physician, must have all the updated details about your patient. One more thing to take care of is to double-check all the details like the policy number or billing address of a patient.  

Establish a Well-Structured System for Denial Management  

One of the most demanding parts of healthcare is Denial management. Whenever the claim returns to the healthcare provider, it puts immense pressure on the revenue cycle management team to quickly sort out problems. It is a shared responsibility of physicians and medical coders to prevent the claims from getting denied. Whenever the claim gets denied, the assessment must begin right from the front end. It should be seen with scrutiny if any part of the procedure was overlooked. Once the error is captured, it has to be logged into the electronic health record. This is to prevent future problems while filing claims. Moreover, the most important thing is to resolve the error associated with claims denials. 

Get Professional Help 

Medical billing is an undeniable part of a healthcare organization’s financial stability and success. It is important to consider that the medical billing landscape constantly evolves, and new challenges keep arising. The key to overcoming these emerging challenges is staying updated with industry trends, regulatory changes, and technological advancements. To keep up with the ever-changing healthcare landscape, healthcare providers must embrace a culture of continuous learning and innovation. 

Their team of experts at Eminence RCM understands the unique challenges healthcare organizations face. They provide tailored strategies to enhance your RCM efficiency. Partnering with a medical billing service provider like Eminence RCM can help you streamline billing operations, reduce costs, and maximize revenue.