Medical Billing since its inception has both equal parts of Healthcare providers and insurance companies. For Healthcare providers it’s more in the part of reimbursement while for the insurance companies it’s holding their profits. As the Billing became more and more complex with an inclusion of other regulations the need skilled billers and coders was felt in the total healthcare sector.
Mr. Lee. B an Operations Managers at MedicalBillersandCoders.com (MBC) from last 20 years has strongly commented about the changing structure of health care sector,” The early concept of fee-for-service (FFS) had given a sense of security and understanding for a physician wherein the revenue generated was dependent on the factor- number patients. Now as the shift started towards providing healthcare for all it became a business for insurance companies to earn through premiums. Now we have value-based payment model were in a doctor will be judged on different factors and then will be paid accordingly. The need of a team of coders and billers is looking to peak with more compliance issues coming-up.”
Medical Billing companies currently act as a bridge between the payers, and the service providers any glitch in the two parts indirectly affect our coding and billing process. This has even got some worst nightmare for the medical billing and coding company.
- Lack of Transparency from Insurance Companies
Whenever a claim is submitted, there is always a 50 to 50 percent chance that the medical claim might be rejected or accepted. Thus, in turn, when the claim is rejected the reasons for the rejection mentioned in the Explanation of Benefits (EOB) are coded in words understandable eats up more time for a biller to prepare a reclaim or re-appeal. For simple coder and biller to solve the problem of revenue management will cripple down your RCM process. The need of channelized transparency between Medical Billing and the insurance company will promote the health care billing system.
- Surprise billing for the same patient from physicians
This can be unavoidable in many circumstances for a patient visiting the clinic again and again for diagnoses and treatment. This means after a certain time the billing companies have to revisit the insurance company with the claim of the same patient.
This leads to a pile up from the insurance companies in terms of payment posting. Many times it might take over a month to settle a simple claim which might even act as a back burner for billing company and physicians.
In many of such circumstances, a physician can become a great help, through providing bundled information for the total billing can save up the cost and time of both insurance companies and billing.
- Lack of diagnoses and treatment documentation from the physicians
The information is an important aspect for a medical billing company which is used to file claims and prepares appeals. In many cases it might happen so that the physicians forget to add certain information in between the claims and after coding when the bill is sent to the payer for payment posting they find an incomplete information on the part of coding, where after certain medical procedure another medical procedure must take place, this makes the billing channel a glitch bound.
- Revived federal laws and modifiers
Federal laws have always been a kind of back burner for the physicians and the billing companies. Now with billing companies coming under the scrutiny of federal government, many billing companies have employed a full-time admin regulator looking over the changes in the federal law.
Now over coming this nightmare for any medical billing company can be an uphill task but with a systemized medical billing and coding company you can save up on reimbursement of physicians and have satisfied client base.
One of the major challenges for the Billing Company is to provide an end-to-end compliance and regulation management.
MedicalBillersandCoders.com (MBC) can help you with your medical billing service challenges with over 20 years of experience in the healthcare sector; we have more than 75 billers, coders and revenue managers working on your billing challenges.