Top 10 Challenges in Medical Billing Today and How Atlantic RCM Solves Them

Did you know that doctors in the US lose an estimated $125 billion each year due to poor medical billing practices? As a healthcare practitioner, you may have come across several billing and coding challenges that would have financially impacted your practice. As the healthcare sector keeps evolving, it is crucial to gain a comprehensive understanding of all medical billing and coding challenges and how you can eliminate them to improve your practice’s revenue cycle.

Here are some of the top medical billing and coding challenges you need to know and how, with Atlantic RCM, you can address them to maximize efficiency and patient care.

Top 10 Medical Billing Challenges and how Atlantic RCM Solves These Challenges

Missing/Incorrect Patient Information

An estimated 80% of US medical bills contain errors. This is a common issue that occurs when there’s missing information or incomplete information like accident date, patient name, patient admission date, etc. Similarly, entering or submitting the wrong patient information also have the same consequences. Examples of such errors include incorrect spelling of patient’s name, wrong numbers in the date of birth field, incorrect insurance policy number and payer’s name.

How we help?

To solve this problem, Atlantic RCM establishes a tracking mechanism to identify denied claims and the reasons behind them. The tool continuously monitors the denial management process, identifying any discrepancies in documents submitted such as inaccurate or missing information.

Through aggressive follow-ups on the information from patients and healthcare providers, our automation system fetches missing information without manual intervention, thus helping fixing denials faster.

Missing Documentation

Providing insufficient documentation will not only lead to denied claims, but also lead to delayed payments and legal repercussions. Examples of important documentation required include the diagnosis, treatment plan, records of services provided, patient registration, etc.

How we help?

To solve documentation problems in medical billing, Atlantic RCM uses a centralized database to store patient records, ensuring they are organized and easily accessible. The platform’s automation capabilities enable it to flag missing documentation and prompt medical staffs to collect the missing documents before submitting claims.

Coding Complexities

Coding complexities involve using outdated or incorrect codes by the biller or coder. This can happen either by upcoding, where billing is done for a more complex or expensive procedure than what was performed or by downcoding, where billing is done for a cheaper procedure than what was performed. These are also major causes for denied claims.

How we help?

Atlantic RCM solves the problem of incorrect coding by providing comprehensive training on the latest CPT and HCPCS codes to medical coders and keeping them up-to-date with the latest coding guidelines and regulations. Additionally, Atlantic’s robust coding software offers real-time coding assistance, audits, and compliance checks.

Compliance With Regulations

Medical billing compliance ensures that healthcare providers and administrators conduct ethical and accurate billing and coding practices. Regulations surrounding medical billing compliance include:

• Federal laws such as Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA).
• State laws
• Medicare & Medicaid guidelines.

Healthcare providers must adhere to compliance requirements to avoid civil lawsuits, penalties, lost revenue, and loss of reputation.

How we help?

However, it can be a challenge for healthcare workers to keep track of regulatory changes, which is why Atlantic RCM establishes compliance teams, conducts regular audits, and leverages technology to keep their systems automatically updated on the latest regulations and compliance standards. Some of the compliance protocols include HIPAA, SSAE-16 SOC-1, SOC-2, HIPAA HITECH, PCI-Level 1 DSS, and NIST 800-53.

Claim Rejections

A few factors like complex insurance policies, varying coverage plans, and inaccurate patient data can make insurance verification more challenging. The chances of claim denials are significantly high, which will impact overall revenue as a result of increased administrative costs due to resubmissions and reimbursement delays.

How we help?

Claim rejections is one of the biggest challenges Atlantic RCM aims to eliminate by offering full visibility into each claim to uncover errors that led to its rejection. After this, the denial management team performs a complete examination of billing documentation and procedures through their denial tracking mechanism to identify root causes and immediately rectify them.

Payment Delays

After submitting claims, healthcare providers have to wait for prolonged periods before receiving the payment. The causes for this include high processing times, high volume of claims, and administrative inefficiencies in their reimbursement process. This will have a negative impact on the healthcare’s revenue cycle.

How we help?

To solve this problem, Atlantic RCM streamlines billing processes by using automation tools to expedite claim submissions and verification, improving documentation, and managing A/R recovery. This is done to ensure that claims get paid and the patients pay the charges that are due.

Atlantic RCM’s dedicated A/R recovery team maintains highly effective A/R processing to increase recoveries, even from accounts passed off as bad debts. We also ensure quicker cash conversions and help speed up payments to improve your healthcare’s liquidity.

Lack of Transparency

The lack of transparency in medical billing can subject patients to surprise medical bills, which only increases their financial burden and possibly impacts their access to future care. This will not only leave patients confused and frustrated, but will also lead to lack of trust for your healthcare services.

How we help?

It is essential to provide upfront, transparent pricing information to patients covering all costs such as insurance coverage and out-of-pocket expenses. Atlantic RCM helps implement standardized billing practices with clear invoices that display the services rendered, codes used, and all charges to help patients understand their billing statements.

Outdated Softwares and Technology

Using outdated medical billing softwares can pose significant risks to both patients and healthcare providers. It can also lead to hefty fines if they are audited and found to be non-compliant with HIPAA regulations. Hence, it is crucial to maintain up-to-date billing softwares to ensure privacy, accuracy, and security of patient health information.

How we help?

Atlantic RCM specializes in offering the latest medical billing and revenue cycle management platform, equipped with the latest technologies and updated with all compliance standards and regulatory information. Additionally, we also provide a robust insurance discovery software that can identify billable insurances for self-pay patients or in case patient insurance information isn’t available.

Our benefits verification software also streamlines the patient eligibility verification process, eliminating the need to have to wait for manual confirmation from the insurance company.

Challenges in Staff Training & Education

As the healthcare industry continues to evolve, the need for proper training and education of medical staff on efficient medical billing and coding procedures cannot be overstated. Medical billers and coders need to stay updated with medical code information and guidelines to minimize coding errors and stay compliant with regulations. This can increase the chances of claims being approved on the first submission, ensuring patients are treated right and on time.

 At Atlantic RCM, we ensure that our workforce is trained regularly and are well-versed with the latest technologies, industry trends, and compliance standards to help keep track of all your insurance claims in the best way possible. By outsourcing your entire revenue cycle management to us, our trained and qualified staff will handle all your medical billing and revenue cycle activities, allowing you to concentrate on administrative tasks and taking care of your patients.

Data Security Threats

Data security threats such as mobile data access, ransomware attacks, poor security measures, and lack of security education are common issues that medical practitioners face. Unauthorized access or misuse of financial or patient information will have negative implications on not just patient treatment, but also the revenue cycle of the healthcare service.

How we help?

Atlantic RCM’s billing platform uses robust security measures with advanced data encryption, secure access controls, and conducts regular security audits to ensure data security and regulatory requirements are met. Healthcare workers also should be given proper training to raise awareness about data protection best practices.

Atlantic RCM has the potential to revolutionize your medical billing and coding requirements and with our revenue cycle management platform, you can streamline medical billing, eliminating all associated challenges. Contact us today and learn more about how we can benefit your RCM services.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com