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Addressing Challenges in Medical Billing

April 1, 2021
April 1, 2021

Whether it is a bill from a medical office practice, a freestanding surgery center, or a regular acute care hospital, there are some common medical billing issues that can impact revenue as well as patient perceptions of their experience. What are those issues and what is the best way to address them?

Know the Most Common Medical Billing Issues

There are four issues that have consistently remained problematic in medical billing. They are:

1. Patient education -- Many of a patient’s medical expenses remain “invisible” to them. Healthcare pricing is typically a bit less than transparent, and patients (particularly those that are newly-insured) might assume that having insurance is all they need to completely cover costs associated with office and hospital visits. When Obamacare resulted in coverage for millions of people, many of them had high-deductible plans and did not understand that a significant medical event could leave them with up to $10,000 in medical bills for which they were responsible. A communication plan to help patients understand their financial responsibilities is an essential element in healthcare finance.

2. Coding errors – These mistakes remain a significant issue even as hospitals have become more experienced in applying ICD-10 codes. Incorrect coding of a medical service will usually result in a denial of a claim. Frequent communication between clinicians and billing staff, along with regular medical billing training and education to update staff on coding requirements, are essential to eliminating these errors.

Whether it is a bill from a medical office practice, a freestanding surgery center, or a regular acute care hospital, there are some common medical billing issues that can impact revenue as well as patient perceptions of their experience. What are those issues and what is the best way to address them?

3. Incomplete Patient Information– Failing to capture relevant patient information is still a very common barrier to full and timely reimbursement. Scheduling and registration staff are essential to this effort. Medical billing training and education to help staff understand the information that they need to collect along with the importance of this information is essential.

4. Manual Claims Processes – While many claims processes are now automated, there are still practices that rely on cumbersome and error-ridden manual processes and suffer the reimbursement consequences.

Efficient Medical Billing Processes May or May Not Result in Improved Revenue Cycles

Even if our processes to educate patients and bill them correctly work well, medical debt remains a significant issue for consumers. In fact, it is medical debt and not poor or

irresponsible spending habits, which is the number one contributing factor in personal bankruptcies. So what is behind an increasing load of consumer medical debt?

A higher number of insured patients may not necessarily result in an improved accounts receivable sheet. Some patients may be unaware that their insurance plan requires them to be responsible for up to 20% of their medical expenses and carries a deductible of up to $10,000 in some cases.

Patients are delaying medical care. Financial concerns may play a part in a patient’s initial decision to delay medical care, but often does little to improve their financial situation as those delays can sometimes result in lengthier and costlier treatment. That more costly treatment can result in increasing medical debt for some consumers. Snowballing medical debt has far-reaching effects—bankruptcies and drained savings accounts can be the result of large or unexpected medical bills.

Making Strides Towards Patient-Friendly Financial Communication

The Healthcare Financial Management Association’s (HFMA) Patient Friendly Billing Project has the tools to help healthcare organizations work with patients towards a less-punishing process. The initiative is based on HFMA’s research showing that patients want financial information that is clear, concise, correct, and patient-friendly.

In addition to establishing these parameters for patient financial communication, HFMA also has published best practices in patient financial communication with unique strategies to address financial communication for each healthcare setting. Medical billing training is essential for staff connecting with patients about financial matters.

Because deductibles are likely to remain relatively large and insurance and healthcare expenses will also remain significant line-items in many household budgets, it will be important to embrace best practices in patient financial communication to keep patients informed, comfortable with their understanding of their financial responsibilities and to protect revenue cycles. It is also important to provide staff with regular training to address the need for accurate coding and full and accurate patient billing information.

All staff with patient access must perform effectively to ensure the success of the revenue cycle in its entirety. With the shift toward high-deductible health plans and the growth in newly insured individuals, Patient Access is faced with communicating and collecting increasingly larger amounts for which patients are financially responsible. In addition to patient communications, these employees must fully understand insurance plans, coordination of benefits, medical necessity and ABNS, and the importance of the demographic and insurance information they collect and record. Learn about HealthStream solutions for training general Revenue Cycle and specific Patient Access staff.