8 Biggest Medical Billing Challenges

Your practice needs strong medical billing processes to stay financially healthy. But medical billing challenges are common. From updating patient information to dealing with denials, your medical billing processes affect every area of your practice. Here are the eight biggest medical billing challenges and how your practice can avoid them.

Medical Billing Challenges #1: Building the Right Team

Your team of medical billing specialists should not be an afterthought. If your billers struggle with your practice management system or have difficulty communicating, your revenue cycle will suffer. By hiring an experienced team of medical billers, you can help your practice increase revenue and improve processes so you can do more with less. Your practice can also consider getting support from a revenue cycle management company by outsourcing or co-souring your medical billing.

Medical Billing Challenges #2: Keeping Patient Information Up-to-Date

Clean claims start with accurate patient information. If your practice is not regularly verifying patients’ insurance information, you risk increasing your days in A/R because of eligibility denials. Your practice should have processes in place to verify insurance coverage, eligibility, and authorizations needed prior to check-in. Payers can also deny claims for minor errors in patient information, so patients should also verify their demographic information.

Your practice can use tools like NextGen’s Patient Portal (formerly Medfusion) for patient information updates. With Patient Portal, your patients can verify or change their information directly in your system. This prevents data transfer errors from paper forms and saves your front desk staff time.

Medical Billing Challenges #3: Insufficient Coding and Documentation

To create clean claims, your medical billing specialists need to start with accurate coding and documentation. But providers have limited time during office visits, and EHR difficulties are a frequent cause of physician burnout. Overwhelmed providers may miss relevant codes or supporting documentation.

You can address persistent coding and documentation problems with workflow redesign and training. During a workflow redesign, you assess and adjust your coding and documentation processes to make them fit into your providers’ day-to-day work. An efficient office-visit workflow, for example, includes documentation and coding during the patient visit. You can also enable EHR tools that alert providers to missing codes and documentation in real-time. After you have developed your new workflows, training can help you bring all providers up to speed. EHR training increases system satisfaction and reduces the risk of burnout.

Medical Billing Challenges #4: Different Requirements for Different Payers

Medicare, Medicaid, and commercial payers all have different billing requirements. Medical billing staff can spend significant time cleaning claims to align with differing payer requirements. You can address this challenge by automating as much of your billing process as possible. For example, in your NextGen EHR and EPM, you can customize NextGen EHR templates for common payer rules to help you collect the right information during office visits. This prevents time-consuming data entry after the fact. You should also take the time to build a robust claim edit library to scrub claims prior to submission to your clearinghouse. You can also automate claims submission. With scheduled batch submissions, you can lower the processing load on your system by submitting all claims outside of regular business hours.

Medical Billing Challenges #5: Tracking and Resubmitting Denials

By one estimate, 5 percent of all claims are denied. Plus, 50 percent of denied claims are never resubmitted. Keeping track of denials and resubmitting clean claims is complex and time-consuming. If your practice has a high denial rate, you may lose out on significant revenue.

To address claims denials, start by exploring the common reasons for the denial. If your practice has a high denial rate for missing documentation, you may need provider training and support. If you have a high denial rate for inaccurate patient information, your check-in process may need fine-tuning. Your practice management system should have built-in tools that can help you see patterns in your claims denials so you can address the root cause.

Medical Billing Challenges #6: Reconciling Transaction Posting with Bank Deposits

Reconciling bank deposits with ERA and payment posting can be time-consuming and overwhelming. Sifting through payments and adjustments can take your medical billing staff away from important tasks like resubmitting denials and working delayed payments. Tools like the NextGen Background Business Processor can automate importing ERA files into NextGen EPM so that when the deposits clear the bank, they can be immediately posted in the system.

Medical Billing Challenges #7: Managing Accounts Receivable

Your practice should aim to keep your accounts receivable aging to 50 days or less. If your practice struggles to collect on accounts receivable timely, your revenue cycle and accounting processes suffer. Accounts receivable difficulties may reflect an overworked medical billing staff. If your billing department does not have time to focus on managing accounts receivable, automating simpler processes can help free up time.

Tools like TempDev’s Revenue Cycle Dashboard NextGen EPM Report can help your staff keep track of accounts receivable. By summarizing A/R by account and age, your team can spot underlying problems and trends rather than working accounts one at a time.

Medical Billing Challenges #8: Collecting Balances from Patients

Collecting balances from patients often requires direct communication. Time-consuming phone calls can make it harder for your medical billing staff to keep up with their work. You can improve patient collection by offering multiple ways to pay. Collecting co-payments upfront can save both you and your patients time. With the NextGen Patient Portal, your patients can estimate their costs and pay any copays online before they arrive for their visit. The Patient Portal also offers online bill pay, so patients can check and pay their balances any time, from anywhere.

How TempDev Can Help with Medical Billing Challenges

TempDev and TempBill can help your practice get paid more, faster. With TempBill’s staff augmentation and outsourcing services, you can get the medical billing staff you need. And with TempDev’s revenue cycle consultants, project managers, and trainers, you can build custom tools and automation to improve your billing processes.

Call us at 888.TEMP.DEV or contact us to get started solving your medical billing challenges.