How To Overcome Medical Billing Challenges In 2021?

March 4, 2021 33 Comments Medical Billing

Whether it's a small medical practice or a large healthcare organization, there will be some common medical billing challenges that can greatly impact the whole revenue cycle of practice. In this article, we listed the top medical billing challenges and how to overcome them in 2021.

Clinical Documentation

This shift to remote operations when appropriate only exacerbated the challenges of obtaining accurate clinical documentation and coding for a novel virus never documented before by providers.

The first code providers could use to document COVID-19 was an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) emergency code created by the World Health Organization in March 2020 for confirmed cases after April 1.

Since then, there have been at least a dozen new ICD procedure codes related to the virus and many more changes to the Current Procedural Terminology (CPT) and Healthcare Common Procedural Coding System (HCPCS) code sets to account for COVID-19 and related conditions and procedures.

Meanwhile, healthcare organizations turned most outpatient visits to virtual care appointments in a matter of days. And while payers were seemingly on board with the shift to telehealth, promising to pay providers for the services, coders and billers were tasked with discovering how to document and bill for the new services amid frequent policy and regulation changes. With so many changes, it is not surprising that financial leaders at US hospitals and health systems identified confusion over COVID-19 coding and claim requirements as one of the top issues impacting revenue cycle operations in 2020.

Education & Training

Education and training have been one of the tried-and-true best practices for coding and billing teams. Yearly updates to coding sets and payer reimbursement policies necessitate frequent training sessions for both coding and bill team members and clinicians documenting care at the point of service. But COVID-19 has shown a spotlight on just how important education, training, and communication are to ensure accurate documentation and denial prevention.

Healthcare Automation

Practice management solutions, computer-assisted coding solutions, and other technologies have helped healthcare organizations fill coding and billing gaps for years now. And during normal operations, the solutions seem to be supporting a strong revenue cycle. However, COVID-19 even threw vendors a curveball when it came to designing technology that aligns with coding and billing workflows even as they rapidly change to accommodate new codes and services.

Like healthcare organizations implementing telehealth, the software company designed for specialty EHR, practice management, and other solutions had to revamp their products. Changes included a new telehealth option within the solution, off-site patient check-in, and more automated coding and documentation workflows at the point of service.

Medical billing and coding have been a major use case for automation in healthcare, with many vendors leveraging artificial intelligence, natural language processing, and other more advanced analytics to scour patient records and identify the appropriate codes based on clinical documentation. These solutions are typically referred to as computer-assisted coding.

Providers have praised computer-assisted coding solutions lately, citing high satisfaction with vendors and capabilities and increased coding productivity and accuracy. But as of now, computer-assisted coding and other automated coding systems still need manual coders behind them to ensure coding accuracy, according to some reports.

Filing Multiple Claims

Having to file multiple claims is frustrating for many, but particularly for specialty providers. Nephrologists, for example, have to file hundreds of dialysis claims at a time. Without a mass claim creation tool, they are left to file each one individually. This has a huge negative impact on practice efficiency and clinical workflow.

Medical Coding Errors

These mistakes remain a significant issue even as hospitals have become more experienced in applying ICD-10 codes. Incorrect coding of medical service will usually result in a denial of a claim. Frequent communication between clinicians and billing staff, along with regular medical billing training and education to update staff on coding requirements, are essential to eliminating these errors.

Final Thoughts

The right way to overcome these kinds of challenges is to go with the best medical billing software. Vozo Medical billing software offers on-site support during implementation, customizable billing tools and reporting, clean claims, automated medical scheduling, automatic payment posting, and more.

Ready to improve your practice revenue cycle management? Then it’s the right time to get started with Vozo

schedule a demo