Top 4 billing challenges facing healthcare providers

Even as drastic electronic overhauls are underway, improving the ways that healthcare providers record and track patient health and well-being, many practices find that one of the biggest challenges is simply getting paid. Medical billing can be a complicated and drawn-out process, especially without medical office software. These are just four of the biggest billing challenges facing healthcare providers today.

1. Making sure to collect full copays
As Healthcare Finance News notes, copays work as a down payment in many ways, and if providers don't get the full amount upfront they may struggle to get the rest of the patient's portion of the bill. There are several ways that these losses may be avoided. First, the front desk should have a clear policy about asking for a credit card to cover patient copays during check-in and before the appointment. For amounts that will not be covered by insurance, administrators should ask for down payments on top of deductibles. For a more automated approach to collecting this money, a merchant account service working within the office's practice management system is helpful, so that down payments may be placed on debit and credit cards.

2. Not auto-checking insurance coverage electronically
Patients aren't always knowledgeable about their insurance coverage, which makes automatically checking the eligibility of every individual who walks through the door an absolute must. All offices need the technology to automatically verify insurance; otherwise there could be serious revenue losses and billing headaches down the line.

3. Approving procedures that aren't covered or require pre-authorization
All insurance plans are different, and sometimes companies can be surprising with what they will or won't cover. When a healthcare provider is preparing to perform a high-cost procedure, he or she should know what the patient's plan covers. Nowadays, many employers are choosing plans with reduced coverage for their employees. As a result, there may be some patients who are unable to cover the cost of their portion. One alternative may be to offer patients a payment plan for procedures in which they incur a significant charge.

On the same note, since some insurers won't reimburse specific procedures unless they've been pre-authorized, providers must be certain to clear them with the appropriate insurance companies before moving forward.

4. Forgetting to stay current on coding
Providers need to use specific medical billing codes for services and procedures they offer, and as with any other industry, these codes are often being updated and rewritten - sometimes offering higher reimbursement.  Be sure to review changes at least once a quarter to optimize your revenue.

An Alternative to In-House Billing:
Many providers opt to outsource their medical billing to experienced medical coding and billing specialists.  The practice manager, often in tandem with the physicians, reviews the practice's staffing and finances and makes the most appropriate decision.  Regardless of who handles the coding and billing, the individuals must stay up-to-date with all the changing guidelines for payer rules, state reimbursement and coding.

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Blake LeGate's picture

Blake LeGate

Sales Representative

Blake is a NueMD Sales Representative for Nuesoft Technologies. He earned a Bachelor of Arts degree in journalism and mass communications from the University of Georgia, and an MBA from Berry College. In his spare time, he enjoys traveling, movies, and watching the Georgia Bulldogs.

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