Medical Billing Trends in 2023 and How to Resolve Common Medical Billing Challenges
- There is a continued shift to value-based care models –
- There will likely be an ongoing move away from traditional fee-for-service models and towards value-based arrangements like accountable care organizations (ACOs) that prioritize quality and outcomes. This impacts how providers are reimbursed.
2. Then there’s the rise of consumerism.
- Patients are taking more interest in healthcare costs and shopping around. This means medical billers need to provide cost transparency and make billing processes more patient-friendly.
3. We’ve all seen a significant increase in high-deductible health plans.
- As health plan deductibles rise, patients bear more responsibility for healthcare costs. Medical billers may need to collect more payments directly from patients.
4. We are seeing more and more billing automation.
- Billing software and automated systems will likely expand as technology aims to streamline processes and reduce overhead costs. However, human oversight is still needed.
6. There is an overall shortage of medical billers –
- High demand and an aging workforce is resulting in a talent shortage. Recruitment and retention initiatives may be needed.
7. There is a drive for healthcare organizations to share data and information seamlessly. This could necessitate upgrades to medical billing systems.
8. Use of telehealth services expanded during the pandemic and is likely to continue. Updated billing practices for distant services will be important
Tips for medical practices to resolve common medical billing challenges:
- It is always important to invest in billing staff education and training. Make sure staff are kept up to date on changing regulations, coding guidelines, and insurance requirements. Encourage professional development.
- Carefully check billing claims before submission. Review for accuracy, completeness, and compliance to avoid rejections and denials. Use claim scrubbing software if needed.
- Improve charge capture processes. Set internal controls for prompt charge entry, coding, and claim submission. This improves cash flow.
- Appeal denied claims whenever appropriate. File appeals with documentation supporting your rationale. However, it’s important to follow-up persistently.
- Adopt automation tools. Billing software, practice management systems, etc can reduce human errors and speed workflow.
- Communicate closely with payers. Stay current on payer policies. Discuss confusion over denials and appeal unfavorable decisions.
- Monitor aging accounts regularly. Follow up on outstanding claims and unpaid invoices. Use statements, emails, calls.
- Consider outsourced medical billing help. Third party services can provide support and expertise when needed.
- Stay up to date on regulations and guidelines. Seek continuing education on billing best practices and ethical standards.
- Address patient payment issues promptly. Make payment plans accessible and provide estimates for out-of-pocket costs.
The key is balancing diligent follow-up, compliance, technology, and patient-centric financial communications. Mastering medical billing practices takes continued effort.