By Larry Carr
Oct 17, 2022
The Covid-19 outbreak has had a dramatic impact on organizations across all industries. The worst hit is the healthcare industry experiencing several challenges, to date. Not to mention, the pandemic has created a unique set of struggles to the healthcare revenue cycle, like new codes and reimbursement policies, increased claim rejections, loss of revenue, significant process changes and much more. Let us in this blog discuss some of the medical billing issues faced by physicians post pandemic.
More denied claims
Claim denial is something normal when it comes to dealing with payers. The pandemic, however, has exasperated claim denial rates. The average claim denial rate is somewhere between 6 and 13%. In the midst of the changing healthcare scenario, private insurers and other payers have been frequently updating their policies. Failure to keep pace with changing payer policies and guidelines can obviously lead to claim denials. We know that prior authorization requirements are established by payers and they keep updating the procedures and treatments that require approval. Failure to obtain prior authorization can result in claim denials and loss of income for your practice. Simply put, no authorization means no payment. Increased workload, shortage of staff, lack of denial resources, and backlog of procedures all contributed to claim denials, affecting your practices’ bottom-line.
Surprise medical bills
Surprise medical bill is an eye-popping bill after the patient has received care. For anything that is not covered by the carrier, the provider must inform and collect it from the patient. If your billing team is not competent enough to provide an upfront cost estimate at the time of visit, it will be challenging for you to collect the reimbursements from the insurance provider. Surprise medical bills reached an all-time high post Covid. The No Surprises Act was passed in January 2022 to protect the patients against surprise billing for unexpected out-of-network cost for both emergency and non-emergency care. Hence, providers and healthcare facilities are literally banned from sending balance bills to patients to collect higher amounts. In case you lack the resources to manage such surprise bills, then it will significantly impact your monthly collections and practice’s revenue stream.
Lower telehealth reimbursements
Covid 19 caused a sharp uptick in the use of telehealth services. The reimbursements from telehealth services were significantly lower than that of non-telehealth services making it challenging for providers post-pandemic. The associated loss of revenue may be way too much for medical practices to absorb. During the pandemic, though 22 state governments issued laws requiring private insurers to cover telehealth visits, low reimbursements for telehealth services were regarded as a major deterrent. Moreover, laws governing licensure may restrict the geographic footprints of physicians, making payment and billing a problem across states.
Patient billing
The Covid 19 pandemic and the economic downturn have significantly affected health insurance coverage. As employees started to lose their jobs due to the slowdown in economic activity, they also started to lose their employer sponsored health insurance coverage. Unprecedented job losses contributed to a shift in who pays for healthcare. Additionally, the move towards high-deductible health plans has made providers focus on self-pay options. Given the rising popularity of high-deductible health plans, many physician practices are still struggling to collect patient payments.
Lack of billing experts
With frequent updates to coding sets and payer reimbursement policies, it is crucial that you need billing experts to handle your billing needs. So don’t expect your front desk personnel who isn’t experienced and trained to handle your medical billing process. When managing high patient volume before the onset of covid-19, medical practices just filed claims and did not focus much on follow-up of denied or rejected claims. Now that the pandemic has changed the billing environment, you cannot afford a single claim to be either denied or rejected. To keep pace with the changing billing environment post-pandemic, taking the help of highly trained medical coding and billing experts ensures a sustainable financial future.
Providing high quality care has always been a top priority for healthcare providers. The pandemic has caused increasing challenges for healthcare professionals as they constantly battle on multiple fronts. And now that the pandemic is settling down, physicians want to focus on providing quality care without having to worry about timely reimbursements. That is why they have turned to outsource their coding and billing needs to professionals in order to take advantage of their expertise and optimize their revenue cycle management. If you are on the lookout to overcome the challenges associated with medical billing and experience a seamless flow of revenue to your practice get in touch with Scribe4Me billing experts, today.
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Frank Travis
Haley Holmes
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