The Struggle Physicians Face With Medical Billing and Coding Tasks

This guide explores the most common medical billing and coding challenges slowing down healthcare facilities. We also offer tips to overcome them. If you are tired of staying awake at night worrying about billing complexities, this guide is for YOU! Let’s get right to it.

Problem # 1 – Constantly Shifting Regulatory Rules

Keeping up with changing healthcare rules is one of the toughest billing issues. Failing to comply leads to massive penalties. It also damages your practice’s reputation.

Providers spend more than $38 billion every year on compliance. For some hospitals, the regulatory weight reaches a shocking $1,200 for every new patient they admit.

How to Defeat This Hurdle?

Tip # 1 – Use professional associations for compliance help. These groups notify members about critical rule changes so you can prepare.

Tip # 2 – Sign up for industry newsletters. Lawmakers and legal firms send updates directly to your email.

Tip # 3 – Monitor official websites. Sites like the Office of Inspector General (OIG) keep you informed on regulatory shifts.

Tip # 4 – Hire a dedicated compliance officer or outsource to a professional medical billing company.

Problem # 2 – Unique Payer Rules and Requirements

Every commercial payer, Medicare, and Medicaid has its own specific billing criteria. Your staff can waste hours “cleaning” claims to meet these different standards.

How to Defeat This Hurdle?

Tip # 1 – Automate as much of your billing process as possible. Many EHR systems let you customize templates for specific payer rules. This helps you collect the right data during the visit.

This cuts out slow data entry. EHR software also lets you build a “claim edit library.” This cleans your claims before they even reach the clearinghouse. You can also automate submissions. Scheduling batch submissions after hours reduces the strain on your office systems.

Tip # 2 – Hire a professional medical billing company. They employ certified coders. Billing specialists who are trained to handle the specific requirements.

Problem # 3 – Keeping Patient Information Current

Clean claims start with correct patient data. You must verify insurance information regularly. If you don’t, your “Days in A/R” will climb due to eligibility denials.

Your clinic needs a process to verify coverage and authorizations before the patient even checks in. Payers often deny claims for tiny errors in demographics, so patients should always double-check their own files.

How to Defeat This Hurdle?

Tip # 1 – Use a Patient Portal to update information. This allows patients to fix their own data directly in your system. It cuts out manual data entry errors from paper forms and saves your front-desk staff hours of work.

Problem # 4 – Missing or Wrong Coding and Documentation

Accurate coding is the only way to get a clean claim. However, providers are rushed during visits, and EHR issues lead to burnout. Overwhelmed doctors might skip important codes or forget to attach supporting paperwork.

How to Defeat This Hurdle?

Tip # 1 – Redesign your workflow. Evaluate your coding steps to make sure they actually fit into a doctor’s daily routine. For example, make coding part of the documentation process during the visit. You can also turn on EHR alerts that flag missing codes in real time.

Tip # 2 – Provide targeted training. Once new workflows are set, train every provider on the system. Better EHR training increases satisfaction and lowers the risk of burnout.

Problem # 5 – Insurance Claim Denials and Rejections

Verification is hard because of complex policies and frequent plan changes. Some common issues that lead to denials include:

• Wrong Demographics: Misspelled names or incorrect policy numbers.
• No Prior Authorization: Skipping approval for therapies (speech, physical, etc.).
• Ignoring Policy Details: Missing exclusions for experimental or non-covered treatments.
• Coding Errors: Issues like upcoding, undercoding, or missing modifiers.

How to Defeat This Hurdle?

Tip # 1 – Make front-office verification foolproof. Get accurate data the moment a patient registers.

Tip # 2 – Call the insurer for the latest guidelines, even if you think you know them. Always document your prior approvals.

Tip # 3 – Use a claim review and auditing system. Catch and fix mistakes before the claim is submitted.

Tip # 4 – Train your staff specifically on billing requirements to prevent future rejections.

Problem # 6 – Administrative Weight and Physician Burnout

Billing tasks are time-consuming and distract from patient care. Hiring more staff to manage these tasks is expensive for small practices. Because of this, many providers handle it themselves, which leads directly to burnout.

In 2023, half of all practicing physicians reported burnout. Lower than the 2021 peak, yes. Still a crisis.

Emergency medicine. Family medicine. Pediatrics. These specialties face the highest risk. Extreme stress. Long hours. Relentless pressure.

How to Defeat This Hurdle?

Tip #1 – Combine smart EHR systems with AI algorithms. These can recommend diagnoses and treatment plans automatically. Based on patient data. No endless searching.

Tip #2 – Automate routine tasks to streamline workflows. Use intelligent scheduling tools. Match patient availability with your calendar. Less manual work. Fewer conflicts.

Tip #3 – Use automated coding systems for accurate code assignment. Faster billing cycles. Lower error rates. Cleaner claims.

Tip #4 – Outsource the complex billing process. A trusted partner boosts efficiency. Cuts administrative costs. Improves the patient experience.

Conquer Billing Challenges and Focus on Patient Care: How MedyraTech Empowers Physicians

Regulatory Maze Masters: Maintain compliance with ever-changing regulations. Our team stays updated on Challenge #1 (evolving regulatory requirements), ensuring all claims follow the most recent guidelines.

Payer Proficiency Monitors: Rules vary depending on the payer. We handle the difficulties of Challenge #2 (varying requirements for different payers), ensuring each claim is submitted using the correct format and evidence.

Patient Data Protectors: We prioritize accurate patient information, reducing the problems of Challenge #3 (keeping patient information up to date). Our secure platforms ensure efficient data management.

Coding & Documentation Champions: Our professional coders closely review every document. Line by line. This addresses Challenge #4 (missing or incorrect coding). Claims go out right. Denials go down. Accuracy improves.

Denial Defense Team: We fight for your proper reimbursement. Our professionals work hard to tackle Challenge #5 (insurance claims denials and rejections), optimizing your revenue recovery.

A/R Managers: Manage your receivables efficiently. We tackle Challenge #6 (accounts receivable management) by proactively following up on outstanding claims, minimizing delays, and maximizing cash flow.

Burnout Navigators: Free yourself from administrative burdens. We tackle Challenge #7—administrative overload and physician burnout—by managing the complexities of medical billing. The heavy stuff. The time-consuming work. This frees you to focus on what truly matters. Patient care. Quality care. Without the burnout.

By partnering with MedyraTech, you regain critical time. We become an extension of your practice, allowing you to overcome billing difficulties with renewed focus and energy.

Bottom Line

Medical billing is vital to the financial health of healthcare organizations. No debate there. But the billing landscape keeps changing. Constantly.

Practices must stay updated on market trends, regulatory shifts, and evolving technology to keep up. Miss a beat, and revenue suffers.

Looking to optimize your revenue cycle management? MedyraTech is here to help. Always.