What are the Common Medical Billing Reimbursement Issues?

Medical billing services in the USA strive for providing high-quality billing services along with maximizing reimbursement rate. Hence, medical claims are carefully created with accurate information and approved format so that, healthcare providers get proper reimbursements for their rendered services. Medical claim creation and submission is a hectic task. Although, medical billing services pay full attention to accurate medical claim creation process. However, still there remain some errors, which lead to denied or rejected claims.

The ratio of denied claims is very high for less revenue generation in the medical billing services. With strict policies of coding standards and privacy rules, it has become more difficult to create accurate medical claims. The most efficient way to reduce errors in the medical billing process to get more reimbursements is by training your staff. Well trained billing staff increases the chances of acceptance of the medical claim by insurance companies.

Given below are some of the general mistakes that most medical billing agencies make while creating medical claims. Medical billing services can take notes from these mistakes and improve their billing process for getting proper reimbursements.

Common Mistakes That Can Cost Big Time in Reimbursements for Physicians

Insufficient Training for the Medical Billing Staff

Medical billing involves a team for collecting relevant information, processing that information and fetching it into a useful document. Insurance companies only deem those medical claims for processing which have up-to-date, relevant, and to-the-point information. Otherwise, they deny the claim and send it back to the medical billing and coding service even on minor issues. The primary cause of denied claim is by the negligence of the working staff. Either they are not very experienced or lack concentration for creating claims for speedy and proper reimbursements.

Solution

Medical billing services must train their staff enough for creating clean medical claims. Moreover, it is also important that the billing staff should be aware of necessary coding and billing standards such as; ICD and HIPAA. Frequent training sessions should be conducted to ensure the benchmark that leads to correct medical claim submission. It will result in the increased number of approved reimbursements rate.

Insufficient Documented Knowledge

Another reason for denied claims is insufficient or irrelevant documented information in the medical claim. This problem arises mainly in the medical claims of Medicare-insured patients. Due to negligence or other human error, important information sometimes seems confusing or is not stated at all.

Moreover, some diagnostic procedures are difficult to file in the medical claim, especially for the Medicaid and Medicare’s patients.

Solution

Medical billing company makes sure that the healthcare service provider clearly states the treatments, diagnostic and clinical procedures correctly. Also, devise some way through which information is verified securely. Additionally, medical billing and coding service staff should use electronic resources so that, information is clearly stated and the chances of human errors are reduced. Centers for Medicare and Medicaid Services (CMS) have established new guidelines that allow medical billing services to document difficult diagnostic procedures. For Example;

For reimbursements of ASC –Ambulatory Service Centers facilities.

Redundant Data

Data redundancy or duplication of data is another common issue in getting full reimbursements. This issue generally appears in manual handling or creation of medical claim. Insurance companies or payers like Medicare and Medicaid don’t proceed such claims of duplicated information.

Solution

Electronic healthcare records (EHRs) or medical billing software is a new trend in the medical billing industry. Medical claims should be checked twice before sending to the insurance company to avoid inconvenience due to duplication.

Conclusion

The US healthcare industry is becoming more competitive with the passage of time. Generating more revenue and getting more payments and incentives for healthcare service providers is becoming difficult every day. Hence, medical billing services should remove the above-mentioned common mistakes to increase their chances of getting increased reimbursements.

P3Care is a medical billing agency in the USA that serves to get reimbursements for healthcare providers by improving the process of actual medical claims creation.