A physician’s job isn’t confined to patient care. They need to follow the intricate process of medical billing and coding. As accurate billing ensures that the doctor’s office will get timely reimbursement from the insurance payers for the treatment they provide. Now, physician billing is a pretty complicated practice.
Top 5 Reasons – Why Physician Billing is so Complex?
When billing for physicians, billers need to deal with several coding and compliance issues. Also, they must eradicate billing errors for seamless claim processing. Reports show that between 10% and 15% of claims get rejected by the payers due to nominal billing errors. This results in significant revenue loss for doctors’ offices. Hence, physician billing services must eradicate all billing issues to ensure 100% of claim reimbursement. Here, we will discuss the common challenges in physician billing in the day-to-day operations.
1. Complicated Coding Requirements:
Coding is the most vital aspect of physician billing practices. Thus, a coder must have in-depth knowledge of different types of codes used for healthcare services, diagnoses, and supplies. The most used codes in physician bills are ICD-10, CPT, and HCPCS Level II codes. A coder must apply the accurate code with modifiers (If applicable) for the services they provide. Coding perfection will ensure swift claim processing and this way, doctor’s offices can maintain a healthy revenue cycle.
2. Hectic Claim Denial Management:
Claim rejection is the worst nightmare for physicians. Insurance companies deny claims for wrong patient information, coding errors, inadequate documentation, or lack of eligibility. Billers should quickly identify the errors and resend the claim after proper rectification. However, data shows that about 60% of denied claims end up on permanent rejection lists. It contributes to significant revenue loss and hampers the natural cash flow of the physician’s office.
3. Following Regulatory Compliances:
The healthcare sector has complex laws and regulations maintained by the medical authorities. Billers need to have a thorough knowledge regarding updated guidelines, so they can follow them perfectly. If billers fail to follow the guidelines, they may face penalties and financial loss. Also, following strict guidelines will help establish credibility and trust with the regulatory authorities. It is a vital requirement for flawless medical practice.
4. Detailed Documentation:
Accurate documentation is very crucial in the billing procedure. The physicians must submit every document to justify the treatment process they have provided to patients. Insurance payers will thoroughly check the submitted documents to ensure they perfectly align with the services they provide. Also, they must collect the patient’s proof of identity, address, SSN, and insurance plan details. A minimal lack of documentation will result in claim denials. In such cases, the physician’s office must review the documentation error and submit the missing document as soon as possible for clearance.
5. Rising Administrative Burden:
Physician billing solutions perform a wide range of administrative tasks associated with the rendered service. Their responsibilities start when patients initially book a doctor’s appointment for a checkup. After that, they perform insurance verification to ensure that the payer will reimburse the treatment cost. Next, they need to get prior authorization before they render their services. The huge administrative burden often diverts healthcare providers from their primary service, i.e. patient care.
Physicians must properly perform each step in the billing process. Slight billing mistakes will lead to claim denials or delayed payment. Due to this, physicians may lose insurance reimbursements and that will affect their revenue cycle and operational efficiency. Hence, they must efficiently tackle all billing complexities.
However, to avoid billing errors physicians must employ expert medical billers with comprehensive knowledge in this field. Now, keeping an in-house team of billing experts is quite expensive. If doctors outsource physician billing operations to professional medical billers, it will cut about 80% of their operational costs.
The Bottom Line:
Physicians perform a variety of administrative tasks while offering healthcare services. Their basic responsibilities are –
- Providing quality patient care
- Optimizing physician billing and coding process
- Enhancing revenue cycle management
These diverse tasks make their job pretty complicated. Also, while they focus on complex billing and claim processing, automatically they lack focus on patient treatment. In this situation, the best solution to these above-mentioned challenges is hiring a third-party professional physician billing company. They have a learned team of billing and coding experts who will ensure seamless claim processing. Moreover, their expertise will enable physicians to avoid claim denials. As a result, the doctor’s office can maintain its natural cash flow for successful revenue cycle management.
Also, when outsourced service RCM experts look after the comprehensive administrative tasks, and physicians can concentrate entirely on patient care. It will enhance their healthcare services while following strict healthcare compliances. Hence, it will present a win-win situation for physicians, patients, and payers.
