5 Key Challenges in Medical Billing Industry

It is said that the healthcare industry is somewhat different from the other business verticals. The healthcare business involves various crucial functioning including managing patient care, medical billing, patient appointment, and so on. The planning and management of medical stock and resources should be implemented under the supervision of dedicated healthcare professionals.

5 Key Challenges in Medical Billing Industry 1-min

Managing and streamlining the medical back-office and administrative works such as medical coding, medical billing service, or healthcare BPO activities can drain out your energy and time. So, have you wondered what could be a possible solution for dealing with these complexities? Well, to convey in simple terms, hiring a medical billing service provider can serve your purpose.

There are too many challenges associated with the managing of the medical billing process, especially if you do not have trained or experienced professionals. The medical billing industry constitutes a vital pool of jobs such as handling claims, payments, utilization of advanced software for working on the RCM (revenue cycle management), and so on.

Today, in this blog post, we’ll be talking about the 5 key challenges existing in the medical billing industry.

Electronic Insurance Coverage

We often notice that generally, a majority of the patients lack the ability to understand their insurance coverage schemes or process. Hence, it has become necessary to automatically check the eligibility of the patients who visit the hospitals. The healthcare domain should possess advanced technologies and software that would verify the insurance automatically and electronically. If this process isn’t implemented, it could produce severe revenue-based losses and numerous errors in the billing process, causing a terrible headache for you. 

Rejected Claims

A study conducted in the US reveals that nearly 22% of the submitted claims are been rejected. And among these, around 40% of the claims have never been resubmitted. The common reason behind this theory includes the misplacement of claims or inability of the claims to meet their specified deadlines, and so on. The foremost reasons for a claim not being ended up in payment are as follows:

  • Precisely, when the claim is not being received by the payer
  • Or, the payer contradicts the payment, owing to a flaw in the claim. The defect could be either incomplete/irrelevant demography data or a lack of evidence to support the bill.

Collecting Full Copays

Copays at times, work as a better down payment. If the providers do not receive the full amount, they may face the difficulty of getting the remaining of the patient’s bill. But there are numerous ways for avoiding these losses. The front desk should acquire a clarity-based policy, if they wish to get the details of the credit card for covering the copays of the patient, especially during the check-in to the hospital or during the pre-appointment stage. If the insurance does not cover the amount, the administrative team should enquire regarding the down payments. 

Resources and Software 

One of the biggest challenges in the medical billing industry is the lack of customer support, detail gathering of patients, productivity tools, updated software, and other essential resources. Medical billing resources play a critical role as it helps in maintaining the count or error-free claims, thereby, increasing the revenue. On the other hand, medical billing software should be integrated into the billing workflow to enhance productivity and reliability. Providers should be vigilant when the software is introduced as an all-in-one software. Also, a lack of a customized medical billing concept can be challenging.

Filing of the Multiple Claims

Filing of the multiple claims is a cumbersome and time-consuming process, especially for the medical billing service providers. For instance, the nephrology department in a hospital has to file countless of dialysis claims every day. Without an advanced claim creation software, the healthcare authorities or the service providers have to opt for filing them individually and manually, thereby, taking up too much time. This can affect the clinical workflow.

Outsourcing medical billing services has become the bottom line of accomplishing the best healthcare BPO solutions. An effective medical billing company can ensure in streamlining the claim processing services and reducing the claim denials. Offshore Online Data Entry is one of the leading and reputed medical billing and coding company, generating affordable billing solutions to simplify your everyday challenges. For further details, you can drop in your inquiries to info@offshoreonlinedataentry.com 

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