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4 Medical Billing Issues That are Affecting Your Practice Revenue

March 29, 2018

Medical Billing Issues

While your practice’s medical billing process may seem like a pain at times, it’s the backbone of your practice’s revenue cycle. Unfortunately, it’s very common for practices to experience challenges with accurately and efficiently billing payers and patients for medical services. While tracking claims through their life cycle can be very frustrating, an efficient revenue cycle can keep your practice running smoothly. Here’s a closer look at some of the more common medical billing issues and helpful tips your practice can use to improve the process and increase revenue.

1 – Failing to Inform Patients of Financial Responsibility

Medical billing has the goal of collecting the full amount for medical services you’ve provided, but many practices are having a tougher time collecting payments from their patients because of the big increase in patient financial responsibility. According to Becker’s Hospital Report, many people are choosing high-deductible insurance plans, which leaves more of the financial burden for healthcare on patients.

Unfortunately, this huge increase in patient responsibility has made it harder for practices to collect on services. For this reason, having a good payment policy in place for your practice is extremely important if you’re going to keep revenue up. To improve your chance of collecting from patients, you need to not only have a good payment policy, but you need to inform patients of their financial responsibility and your payment policy. Taking measures to simplify bills for patients can also help practices collect more, since many patients find that medical bills are a confusing mix of multiple payment requests and medical jargon.

2 – Failing to Capture Patient Information

Another big issue that may affect your practice’s revenue is failing to capture patient information needed for billing and collecting. The beginning of your medical billing process is actually the very first point of contact between your practice and the patient. It’s important to immediately start collecting information that will lay the foundation for billing. Having a helpful script for employees who initially schedule and registered patients can ensure you capture the information needed to make billing and collection as effective and efficient as possible.

Not only is it important to capture the patient’s basic and demographic information, you also need to make sure that your practice’s front-end staff is verifying the patient’s health insurance status and coverage before services are provided. One of the main reasons claims are rejected is due to eligibility issues, and with the industry denial rate average between 5-10%, it’s important to take preventive measures to lower denial rates to improve cash flow for your practice.

3 – Inaccurate Coding

Even if your practice made it through ICD-10 implementation smoothly, inaccurate coding continues to be the top medical billing issue for practices. Some of the most common mistakes made include:

  • Putting in diagnostic codes and treatment codes that are mismatched
  • Putting in the wrong codes or accidentally confusing codes, such as ICD-10, CPT, and point of service codes
  • Entering too many or too few digits for ICD-10 codes
  • Making an error in the modifiers
  • Insufficiently documenting grafting materials, components, and devices
  • Poor or missing documentation
  • Accidentally transposing digits when entering ID numbers or codes
  • Small errors in patient information
  • Failing to use updated, current code sets

Inaccurate coding can result in an increase in claims denials, so it’s important to make adjustments within your practice to avoid inaccuracies. Ensuring that clinical staff are well trained on the recent ICD-10 coding updates, continuing the education of coders, and ensuring that staff communicate with clinicians when documentation issues occur are measures that can be taken to prevent inaccuracies that result in denials.

4 – Using Manual Claims Management Processes

Unfortunately, submitting claims isn’t as easy as just hitting a button. Good medical billing and coding involves having effective communication channels between clinicians and front-end staff, using data collection tools, and streamlining procedures for managing denials. Managing billing and coding can be complex for any medical practice, but many practices continue to use manual claims management processes to deal with claims denials. The processes surrounding claim submission and denials management are complex, and it can benefit your practice to have an automated denial management process in place.

Manual claims management processes leave you open to more inaccuracies, but automating these processes can reduce inaccuracies and increase revenue by helping practices get reimbursements from denials and rejections faster. Using a vendor solution often helps practices better identify the actual causes of claims denials, better managing resolutions and reducing the number of write-offs for the practice, boosting overall revenue.  Outsourcing medical billing and coding is also an option that proves beneficial for many practices.  

If you’re looking for more ways to boost practice revenue, M-Scribe Technologies, LLC can help. As one of the nation’s leaders in medical claims billing and coding, we offer a number of solutions that can benefit your practice. Contact us today and we’ll help you analyze your practice’s needs free of charge, offering solutions that can boost revenue for your practice. 


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