Medical Billing’s evolution has been nothing short of spectacular. What started as a gruesomely tedious process has been simplified considerably with the advent of technology and AI-enabled Medical Billing and coding software.
Many medical billing service providers have witnessed a significant surge in their client base. This can be attributed to the cost-efficient and time-effective benefits that healthcare practices expect from Medical billing companies outsourcing their services.
In this article, we would like to take a short trip down memory lane to understand what medical Billing was and how significant its change has been in the age of Information Technology.
The Arduous Past
Decades before, intelligent software made billing simple, and medical billing staff was relegated to completing claim forms manually before submitting them to payers. Naturally, this was extremely challenging. Staff members had to spend hours on their typewriters to fill up a claim form. People in charge of creating these forms had to fill up the necessary field and utilize proper spacing to ensure the documents complied with relevant policies and regulations at that time.
Those who’ve used a typewriter will understand how difficult abiding by formatting obligations can be on this archaic machine. If a patient’s information had to be updated, the staff members would have to take the patient’s previous form, update the information in a typewriter and print it again. They had to do this over and over for multiple patients. Medical staff referred to hand-written ledger cards to get the patient information needed.
Moreover, there was no such thing as a ‘quick search’ if one wanted to find specific patient payment or insurance information. Looking for relevant information meant flipping from page to page until you stumbled upon what you needed. Suffice to say. The whole process was jarring and time-consuming. There was ample room for human error, and claim rejection rates were as typical as the rising sun.
Fortunately, things changed for the better as innovations in medical Billing took center stage.
The Convenience of Medical Billing of the Present
Thanks to the leaps technology have made in this decade alone, the healthcare industry has been blessed with tools like electronic claims submission, automated payment processing, real-time eligibility, and automated payment posting. All of the devices mentioned earlier are pretty standard in the medical billing world today. They have contributed positively in alleviating the burden of medical Billing, saving time, reducing claim rejection rates, reducing payment delays, and boosting revenue for healthcare organizations.
In retrospect, however, there are persisting issues that plague the medical billing industry. For instance, obtaining approval from payers or third-party reviewers for requested services can still be quite time-consuming. Reviews of medical records can still take more than ten business days. Such delays can be challenging for both patients and the office staff of a medical practice tasked with informing patients on the status of their requests.
The situation only gets worse if the requests made are denied. Rules about an insurance agency’s policies must be complied with to avoid rejections. As most claims are processed electronically, a denial can be the direct result of a computer glitch. The office staff has to spend a considerable amount of time investigating the cause of denials to make successful resubmission appeals.
It also doesn’t help that the coding rules we have today are unnecessarily complicated and rigid. The administrative burden can still be overwhelming for physicians who cannot afford to hire in-house staff in their small clinics to handle medical Billing. Thankfully, medical billing companies have become extremely popular in their rendering of specialized Billing and coding services to healthcare practices in a bid to alleviate their billing woes completely.
The Future of Medical Billing is Promising
Apart from the rise of third-party medical billing companies, advancements in IT and ICD 10 deadline seek to change medical Billing forever. We are seeing the effects of this change coming to pass gradually. In our opinion, the following trends will impact the medical billing industry significantly in the next few years.
1 –EHR Adoption
We expect physicians around the globe to fully embrace electronic health recording systems. The National Center for Health Statistics claims that 55% of physicians have already adopted an EHR (Electronic Health Record) system in America. This number is expected to surge substantially in the coming years. The widespread adoption of EHR will result in paper becoming completely obsolete in the next few years. Widespread EHR adoption also means the simplification and expedition of payment cycles and coding becoming easier. EHR adoption also foreshadows a future where 99% collection rates might become a tangible reality.
2 – Cloud-Based Medical Billing
Cloud-Based Medical Billing has already been introduced today and will witness significant evolution in the coming years. The Healthcare industry is growing warmer to the idea of cloud-based medical Billing because of its ability to store and access data electronically anytime and anywhere. Although there are security concerns with this technology, acquiring the software from a reputable technology partner will offer excellent security to the patient health information that such software is known for storing. Authorized personnel can easily access this information on the go with the correct password.
3 – RCM Outsourcing
Since 2019, many healthcare practices have decided to outsource their RCM services rather than do them in-house. Outsourcing RCM has helped hospitals save time, resources and alleviate the burden afflicting their office staff. RCM outsourcing has also resulted in cutting costs. It is estimated that a healthcare organization can save up to 30% of operational expenses if they decide to outsource. Outsourcing also results in claims being worked upon by qualified professionals with expertise in Billing, thus resulting in successful claim submissions. All of these benefits combined hint towards more practices leaning towards Outsourcing of RCM in the coming years.
The Bottom Line
In hindsight, the future seems to favor Medical Billing. We’ve come a long way already, moving from the arduous nature of hand-written medical ledgers to automated medical billing software that makes every aspect of this critical task simpler. Practitioners and Patients are in a better position right now than they were just a decade ago. Additionally, the surge in demand for outsourcing medical billing services has also resulted in Billing and coding becoming way more convenient than they’ve ever been.
However, there are concerns, especially with AI and the evolution of coding, threatening jobs in the future. However, the prospects for billers and coders do look bright. Technology and significant policy changes will result in Billing and coding becoming more accurate. Such accuracy will translate into jobs that pay higher salaries. We believe the future holds immense promise for the healthcare industry as medical Billing continues to advance with technology and the introduction of convenient policies.Learn More
Medical billing can be a crucial, but complicated process. It constitutes one of the most vital components of the health care industry, especially the behavioral healthcare sector. What makes the behavioral medical billing process concerning is the frequent billing errors that are pervasive throughout the industry.
Errors in coding are frequent sights to witness, especially when it comes to behavioral health, as such the diagnosis, treatment and coverage for a patient can be extremely messy. This, in turn, makes the claim submission process messy, resulting in most cases with denial of the claim.
Prominent Billing Errors
If we have any chance of combatting the issue of billing, we must first try to understand its cause. Some of the most common errors are listed below.
Errors such as incorrect spellings, typos in insurance ID’s are a major reason for insurance firms denying claims. The name, contact, and address of both the provider and insurance company could be entered incorrectly. This is because the medical bills can be influenced and changed by dozens of people, hence such errors are common
Apart from incorrect information, outdated or obsolete information can also put a wrench in your claim approval ambitions. Outdated information may come from the patient themselves. Claims can be rejected if data is found to be outdated; hence keeping data up-to-date is crucial.
An incorrectly entered quantity can end up charging the patient extra. Even erroneously adding a zero at the end of a number might widely exaggerate the cost of the treatment. Such errors should be avoided at all costs.
Most physicians have illegible handwriting. At this point, this has developed into a cliché amongst various medical professionals. However, this can also result in claim rejections as the handwritten documents are simply too messy to be comprehensive.
Double billing, unfortunately, is a common Behavioral medical billing mistake that has been going on since time immemorial. A patient might be charged twice, once by the doctor and once by a nurse who wasn’t aware of the doctor’s actions. A patient might also be charged twice for both drugs prescribed and drugs administered.
Undercoding occurs when the act of behavioral medical billing for a service is less expensive than the treatment provided, or leaving out codes altogether. Patients might be undercoded by providers to minimize patient’s costs or avoid any audits. Unlike other errors, this error affects the provider more than the patients.
Upcoding occurs when the act of billing for a service is more expensive than the treatment provided. This happens when a billing code is incorrectly changed to represent a more severe treatment or diagnosis. Upcoding has been deemed illegal and can also inflate a medical bill.
Incorrect or Mismatched Codes
Incorrect or mismatched codes can occur when a provider upcodes a patient’s diagnosis without changing his billing code. Mismatched codes can also inflate claims due to upcoding.
Unbundling is an act of billing for individual services that can be covered under a less expensive treatment plan. This basically means that charges which were typically falling under one code are now being listed separately.
Best Practices to Avoid Billing Errors
With the above causes now crystal clear, let’s look at some of the best practices that can help you avoid billing errors, and thus prevent claim rejections.
- • Double Check Patient’s Personal Information
This is probably one of the easiest ways to avoid medical billing errors-simply verify and re-verify your patient’s personal information. Make sure all the information submitted by them is correct and devoid of any silly mistakes and omissions.
- • Double Check Patient’s Insurance Information
Make sure to call your patient’s insurance company before you provide them with your services. Check whether their policy number and coverage are the same and that you have updated billing contact information.
- • Establish a policy to compile billing information
Establish a clear and precise policy that communicates accurately how billing information needs to be handled and managed by your staff. You have to ensure your patients aren’t being charged twice, hence make one person-in-charge of monitoring and managing the staff that handles billing.
- • Follow up on your claims
You can avoid errors by simply being diligent in your follow-ups with insurance companies. A representative working on your claim might be able to inform you of errors, allowing you to rectify and re-submit a polished claim again.
- • Establish Clear Communication and Co-ordination
Everyone working on a claim in your staff should be well aware of their roles and responsibilities. They should also be well organized and coordinated to know how to communicate with each other effectively. Stay up-to-date It is crucial that you stay up-to-date with your claim process and avoid the entry of any kind of obsolete information from your documentation.
DENmaar’s Mental Health Medical Billing Service
As you can guess from the article, behavioral health medical billing is not a walk in the park. A lot of effort, blood, and sweat goes into the entire process. It can be time-consuming and really frustrating for mental health practitioners who just want to tend to their client’s needs.
Here at DENmaar, we partner with concerned practitioners to offer pre-authorization, third party billing, claims follow-up, and to assist with appeals for any denied insurance claims. With DENmaar, you get the assistance of our behavioral health billing specialists to make your billing process easier than ever.Learn More