Running a medical practice — be it a hospital, clinic, etc. — goes beyond the care of patients. Medical practitioners must consider multiple business aspects, such as medical insurance billing. For many, managing day-to-day administrative tasks such as billing can take time and effort. However, there are several ways to alleviate this stress, including digitized processes and systems that allow for accuracy and efficiency. This article explores medical insurance billing, evaluating the issues that cause increased costs and a few key solutions.  

Understanding Medical Insurance Billing 

As expected, the administrative tasks involving medical insurance billing are pretty complex, with several nuances to keep track of. While it may initially overwhelm you, it is vital to have a clear understanding to ensure documentation, billing, and the correct codes are always used. Here are some factors that influence medical insurance billing: 

Coding Systems

Billing codes are often the most complex aspect to navigate since there are regular updates. With the transition to the International Classification of Diseases Tenth Revision (ICD-10), the number of diagnostic codes increased from 14,000 to well over 70,000. While the 11th revision has since been created, it is important to note how codes can change and increase so rapidly. This has led to significant complications in the billing process, which was to be expected. 

Regulatory Compliance

The Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA) are two incredibly important aspects healthcare providers must navigate to remain compliant.  

Denying and Rejecting Claims

This is a frustrating factor since a simple omission or inclusion can lead to insurance claim rejection. For example, the ABA billing code for a comprehensive, adaptive behaviour assessment administered by a qualified healthcare professional for a 30-minute face-to-face session with a patient is 97151. If — when such a claim is processed — the insurance provider discovers that the code was inputted incorrectly, that claim will immediately be rejected. This incurs additional fees since the appeal process will include resubmitting the claim and redoing the entire process. 

Manual Paper-Based Updates

Many healthcare providers still rely on paper-based documentation for billing and coding, which leads to human error. Not only are these paper-based systems time-consuming, but they also have a penchant for error.

Little to No Standardization

Many medical practices have a way to document billing and codes. However, they often do not meet the criteria from insurers, making the entire billing process more complex than it ought to be.  

Solutions To Reduce the Medical Insurance Billing Burden

First and foremost, compliance will ultimately guarantee you are billing correctly and using the correct billing codes. However, there are solutions to alleviate the billing burden, and these include:

1. Utilize Advanced Billing Software 

Investing in billing software can significantly streamline the billing process. Some benefits include automating repetitive tasks that eliminate human error, integrating electronic health record systems that ensure seamless data transfer and accuracy, and real-time updates on claims and rejections. 

2. Implement Accurate Billing Codes

By now, you understand that incorrect billing codes lead to claim rejections and additional fees when you need to resubmit a claim. However, using the incorrect codes also leads to underpayments and overpayments, which increases administrative costs. To preempt this, consider regular staff training. This way, you can ensure your staff is up to date on the latest codes.

Another solution involves regular auditing, which allows you to identify irregular coding practices and codes to rectify them timeously. Lastly, employ certified professionals who are experts in billing practices. 

3. Enhance Training and Education

Learning is always a life-long commitment and continuous learning is even more so. Because of how rapidly billing codes and practices change, it is crucial to stay up to date. Investing in training and education for your staff will allow them to remain up to date at any given time. This also leads to fewer billing errors and improves efficiency. 

The training can include billing procedures with detailed instructions, including the codes. It should also include a section on policies so that your staff understands medical insurance — who the payers are, what coverage is, and what codes are to be used for said coverage. Lastly, compliance training is vital and should include regulatory changes and compliance requirements.

4. Outsourcing Billing Services

There are several advantages to outsourcing billing services. For example, Your Missing Piece is an expert service provider that offers ABA billing services. Organizations such as these have been paramount in the medical industry and have not only saved medical practitioners valuable time and money but also allowed for efficient and streamlined billing.

Organizations like Your Missing Piece are experts with specialized knowledge, giving you peace of mind. Contrary to popular belief, they are a cost-effective method, as they eliminate the need to employ staff to conduct the same tasks. Lastly, they allow you, as a medical professional, to focus on patient care, which is ultimately the goal.  

5. Effective Communication and Coordination

To have a sufficient and successful billing process, each department at a medical facility should communicate effectively. For example, all billing processes and codes should be the same across departments, and how this is managed should be centralized; in other words, only one system should be used to avoid confusion. Conduct regular meetings, have clear documentation, and utilize collaborative tools that allow cross-collaboration.  

Alleviating the Stress That Comes With Insurance Billing

Reducing the medical insurance billing burden is crucial for healthcare providers to maintain financial stability. The aim is, first and foremost, to provide superb patient care. However, administrative tasks such as billing have sometimes become a burden. For this reason, medical practitioners should utilize billing software, implement accurate billing codes, enhance staff training, outsource billing services, and incorporate effective communication and collaboration between internal departments.