Improved Claim Process With Medical Billing Services

Introduction

The healthcare system of the United States is full of complexities. The different departments of the healthcare system need effective solutions as per their requirements to make their daily tasks easier. One of these departments that demands the utmost effort is the “billing” department. The complex billing system is now simplified with the coordination of third-party companies that offer medical billing and coding services.

How Medical Billing And Coding Service Helps

Medical billing and coding services have helped the healthcare department in several ways. Medical billers are certified professionals who are thorough with the billing process. The billing process includes claim submission, eligibility verifications, and calculation and collection of payments. Medical coders are experts who translate a physician’s report into alphanumeric codes. These codes are universal medical codes. The involvement of medical billers and coders in the billing process has helped healthcare professionals and insurance companies.

Claim Denial: A Hurdle

A major problem existing in the healthcare department is “denied claims”. Denied claims are the claims sent back to the payer by the healthcare supplier, marked as “Unpayable”. Several reasons can lead to dismissed claims. The reasons include coding and billing issues, missed filing deadlines, mixed-up medical records, extra pertinent explanations, and inadequate medical needs.

Medical billers and coders add more accuracy and effectiveness to the process of claim submission.

According to an analysis by Kaiser Family Foundation, on average, 18% of in-network claims were denied during the reporting period. Moreover, the average claim denial rate varied from 1% to 80% depending on the payer. The claim denial rate varies with location. The highest rate was for states such as Indiana and Mississippi, where the claim denial rate was 29%.

The billing process requires cautious handling of the information and details. Slight errors can cause delays and rejections. This becomes inconvenient for patients, doctors, and insurance companies. Claims are denied due to several reasons. In the United States, health insurance claims are rejected because of a few leading reasons, like:

• Registration/Eligibility – 26%
• Missing or Invalid Claim Data – 17.2%
• Authorization/Pre-Certification – 11.6%
• Service Not Covered – 10.6%
• Medical Documentation Requested – 9.2%
• Medical Necessity – 6.6%
• Unknown – 6.4%
• Untimely Filling – 5.4%
• Medical Coding – 4.8%
• Provider Eligibility – 0.9%
• Avoidable Care – 0.7%

One in seven health insurance claims is denied in the United States. More than 30 percent of hospitals are facing the negative impact of claim denials. The loss is estimated to be $262 billion annually for hospitals across the country.

The widespread problem of claim denial has caused huge cash-flow issues. It has also overburdened millions of patients. So, the strategy of preventing claims denials before claim submission is used. Healthcare professionals now exercise getting external help from medical billing and coding companies. This accelerates the revenue cycle, supports patients’ well-being, and improves profitability.

Why Doctors Need A Medical Billing And Coding Service?

Doctors, in particular, suffer greatly due to full or partial claim denials by the insurer. This questions the validity of the patient’s insurance coverage or the submission of correct erroneous codes by the physician. A full or partial claim denial can direct the process in several distinctive directions. The doctor can drop the claim or rewrite it to collect payment by changing the insurer’s decision. Moreover, any administrative error requires the doctor to share the corrected information. The reason for claim denial decides what the next steps should be. The insurer generates a new remittance after every reprocessed claim.

The increasing ratio of patient-to-doctor demands a plan that involves intelligent ways to deal with the extra load. Medical billing and coding companies offer a way out to doctors.

Being a doctor with an occupied medical practice requires a lot of focus. Efficient and accurate coding and billing often become difficult tasks for doctors. Outsourcing a medical billing and coding service is the most optimal solution. It allows doctors to hand over these time-consuming activities to other experts. A professional medical billing and coding company can offer many advantages. The company takes responsibility for handling the coding, billing, and claim submission. Here’s how a medical billing company helps:

• Shifts the accountability focus from the doctor and other office staff
• Eliminates the chance of error
• Professional handling of coding
• The dedicated team assists with avoiding penalties, reimbursement delays, and claim denials
• Improves the revenue cycle
• Assigns specialists who focus their entire attention, time, and training on revenue cycle

Adding a medical biller and coder to your team can help boost your efficiency. Furthermore, it improves your practice and the gives patients the treatment they deserve.