3 common medical billing and coding challenges

Providers can ensure their vital medical billing and coding processes run smoothly by addressing three key challenges, according to RevCycle Intelligence.

Here are the three obstacles to surmount:

1. Manual medical billing.

Coordination of benefit claims was the only common claims management process with a significant increase in automation since 2016, according to the 2017 CAQH Index. Slight increases in automation were observed for claim submission, eligibility and benefit verification, claim status inquiry and remittance advice. Claim payment and prior authorization processes became more manual compared to 2016. Providers could save an estimated $9.5 billion through full electronic adoption of common claims management processes.

2. Neglecting to inform consumers about patient financial responsibility.

Over one-third of providers said they never discuss patient financial responsibility with patients, according to a West survey. Less than one-fourth of providers always go over costs with their patients. To address this obstacle, provider organizations should adopt price transparency strategies, such as developing a list of prices for low-priced, high demand services or a launching price estimate tool.

3. Traditional physician query processes.

In a traditional physician query process, a medical coder sends a question or issue to a medical record specialist or a physician's office staff, who then prints the queries for physicians. Physicians respond to the documents during their administrative hours. Because manual physician queries delay medical coding and billing and don't have a great response rate from physicians, providers should consider automated physician queries. Cumberland-based Western Maryland Health System boosted physician response rates and reduced the query timeline from four days to four hours by implementing a mobile physician query platform. The platform enabled medical coders to send questions to physicians on their phones.

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