According to a Healthcare Business and Technology report, almost 80% of medical bills contain errors. This results in approximately $125 billion of profit loss for U.S. practices. If you have in-house billing, it is important to identify these mistakes and the reasons behind them in order to fix and avoid them in the future.
The Two Most Common Reasons Behind Medical Billing Errors:
1. The Complexity of the Medical Coding System
The International Classification of Diseases, currently in its 10th Revision (ICD-10), will present ICD-11 at the World Health Assembly in May 2019, which will come into effect on January 1, 2022. “A key principle in this revision was to simplify the coding structure and electronic tooling – this will allow health care professionals to more easily and completely record conditions,” says Dr Robert Jakob, Team Leader, Classifications Terminologies and Standards, WHO.
Meanwhile, it is important to keep up to date on ICD-10, which has constant updates and changes, as exemplified on ClaimCare’s post: Impact of Medicare 2019 E&M code changes on a physician compensation package based on RVU.
ICD was originally adopted by the U.S. to provide better data for research, a more efficient healthcare system, and quality, safety, and efficacy measurement of services - believing that it could reduce medical billing errors because of the specificity of services listed on each code.
However, this has resulted in more errors for practices that have struggled to learn and remain updated with the coding system.
Insurance companies have also become stricter with their medical billing and coding practices. The smallest mistake easily becomes a reason for your medical billing claim to be rejected.
This results in a longer medical billing cycle, which may lead to several months of waiting before payment for services are released.
2. Failure to Remain Updated with the Latest Medical Billing Rules and Regulations
Another challenge facing medical practices is how to cope with the aforementioned constantly changing rules and regulations in the medical billing industry.
The release of the Medicare 2019 E&M Code Changes meant another set of codes had to be remembered for your medical billing staff/personnel. The question arises, “Did your organization have the time and skill set to read and implement the changes?
Kyle Haubrich, JD shared the following insights in his article, How the MIPS proposed rule could affect your practice:
"Physicians are frustrated and are becoming burned out with all the regulations they currently have to comply with, so opting in might just be more frustration for them, and not worth the hassle."
Are you feeling the same thing?
Here's how you can get rid of these medical billing problems.
Incorrectly, medical billing outsourcing may seem expensive to some practices and facilities that have never tried an efficient and effective medical billing company. However, the numerous benefits, including the reduced profit loss, will prove to be more beneficial than previously imagined for the practices and facilities that are hesitant to outsource.
Teaming up with a medical billing company erases a need to worry about:
- Changing medical rules and regulations
- Medical claim submission and approval
- Medical coding updates
Most importantly, you don't need to spend on personnel:
You don't even need to think about turnover, training, and staff familiarization over billing software, procedures, and coding.
With Medical billing outsourcing, you gain access to trained professionals, who only make money when you do.
Reduce your profit loss. Consider your options and choose a medical billing company who can help you reduce these mistakes.
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ClaimCare has over 80 years of combined medical billing experience in providing medical billing services to various specialties and states. This includes process engineering, information technology, accounting, and business management. Let's talk. Send us a message.