Common Hospital Medical Billing Hurdles and How to Avoid Them

Medical billing is a challenging, time-consuming, and hectic procedure. This is the same for all the specialties including hospital billing. There are barriers like insurance companies, medical care, and the government which make it difficult for patients to navigate the system. 

The entire procedure is quite uncertain and requires full attention. Thankfully, there are various medical billing processes and procedures, in which some basic standards help to deal with the uncertainty. 

Let’s Understand Hospital Billing 

Hospital billing is when the billing is done for inpatient and outpatient services. These are the services provided by skilled nurses. Also, there is the use of laboratory services, medical supplies, and equipment. 

The process of billing in hospitals should be carried out by professionals to ensure timely payments. Today, there are several hospital billing services available in the market. Out of all these hospital billing services, you must be vigilant enough to choose the right billing partner for your healthcare facility. It is important to take care that the hospital medical billing requires your undivided attention.  

Efficient Hospital Medical Billing and Coding Ensures: 

Timely and Accurate Reimbursement - 

When you get expert medical billing services like Eminence RCM, you will be following quality protocols. The chances of errors automatically go down. This reduces the chances of claim denials and delayed reimbursements.   

Correct Documentation - 

When proper documentation is ensured in hospitals, it helps to streamline workflows and revenue flow in the organization and prevents claim denials.  

Better Safety of Patients -  

When all the medical codes are accurately used, it helps to improve the quality of healthcare for patients.  

How Hospital Billing Works? 

Let’s learn how billing works in hospitals. Hospital billing procedures and processes can be divided into the following simple steps: 

Deciding Financial Accountability  

It is an important step to initiate. At this stage, it is decided how much money will be used for the visit. It will also help decide which insurance policy covers what service. You need to remember that insurance coverage differs. Therefore, not all the services and prescriptions will be covered.   

Check-in and Check-out  

As soon as the check-in is initiated, you need to submit your entire personal and insurance information. The medical report will be generated and sent to the medical coder during the checkout. The report is then converted to the codes and procedures and superbill is formed and given to a medical billing expert.  

Proper Examination of Codes and Ensuring Billing Compliance

It must be ensured that your medical bills meet all the fundamental requirements. Patient information and various other operations performed must also be included. When the bills are passed ahead, it is the duty of medical billers to take care of all the compliance rules.

Preparing Claims and Timely Submitting Them 

After the claims are properly examined with scrutiny, it is time to submit them to the insurance providers. All the claims must be prepared without any scope of errors in it and submitted without any delays. 

Decision-Making 

There is a procedure that demands a payer to analyze a medical claim and determine if it is compliant. Usually, the insurance company oversees this. This is a stage where a claim may be approved, denied, or rejected. 

Critical Observation 

After this lengthy process is carried out, the statement is then sent to you and the patient. There are some cases where you will also receive an Explanation of Benefits. 

Payment Collections 

Once you receive the bill, the patient’s responsibility is to pay any remaining balance that is not due to the insurance company. If the bill is not received on time, it will be forwarded to a collection agency and further action will be taken. 

Complex Areas of Hospital Billing 

Difficulty in Complying with Regulations and Compliance Standards 

To adhere to regulations and compliance standards, hospital billing services must navigate diverse requirements. It includes those mentioned in HIPAA, CMS, and the False Claims Act. Compliance with these mandates is extremely important to mitigate legal and financial risks for healthcare entities.  

Implementing policies and procedures becomes imperative to guard patient confidentiality. It also helps with accurate billing practices and prevents any instances of fraudulent behavior. It is equally important to ensure thorough training of staff members in these protocols to maintain compliance standards. Ensuring the experts for monitoring adherence to organizational regulations and standards. 

Hurdle of Maintaining Proper Balance Between Patient Satisfaction and Financial Sustainability 

In today's medical world, finding the right balance between patient satisfaction and financial stability is a huge task. With patients being the priority, their satisfaction affects not just medical care, but also billing transparency.  

Also, healthcare providers must keep their financial health pumped up to sustain quality care. The question is - How to strike a balance in the revenue cycle?  

You need to prioritize clear communication on costs, offer flexible payment plans, and resolve all the issues in the billing process. Apart from that, ensuring coding accuracy and slashing claim rejections can pump up revenue. It's totally a balancing act, but with the right strategy, it is quite possible to keep both patients and finances in good health!

Properly Managing Claim Appeals & Denials 

The world of hospital billing services is quite fast paced. The process is long and claim denials are inevitable if undivided attention is not given. This directly hampers the revenue of your healthcare facility. But you don’t have to worry as various hospital billing services like Eminence RCM can help to manage these obstacles for you. The first step is to understand the mystery behind what is causing denials. Is it mishaps in coding, improper medical necessity, or any kind of missing or incomplete paperwork? 

When you do complete research and identify the issue, you will be able to resolve it accordingly. The issues can include - providing additional documentation or appealing the decision to the payer. In the entire billing process, it is important to track denials and appeals to identify different patterns and areas for improvement. 

Tips to Navigate Complexities in Hospital Billing 

Let’s discuss some best practices to proactively avoid claim denials:  

Collect Complete and Accurate Patient Information  

Remember the fact that even a single blank field or wrong data can result in a claim denial. Some of the examples of important information that must be double-checked are - the patient’s name, date of birth, policy number, insurance payer, etc. 

Use Technology 

The times have changed, and the process of handling hospital billing has also evolved.  It is important to automate tasks, streamline your workflows and speed up the process of collecting and presenting information. 

You can invest in professional hospital billing services and electronic health record (EHR) systems. This prevents important data from getting lost while ensuring more efficiency and accuracy.

Verify Referral and Authorizations

It is important that you are aware that which services demands referrals and prior authorizations. Make sure you take time to learn that. It will help you mitigate issues related to eligibility and pre-certification.  

How can Getting Hospital Billing Services from Eminence RCM Help?

It is a common problem in healthcare facilities that they cannot manage the revenue cycle properly. To keep up with the industry standards, it is important to get the best hospital billing services like Eminence RCM.

Getting Hospital Billing Services from Eminence RCM will: 

Saves Your Time and Financial Resources 

It can be an extremely costly procedure to take care of patients along with carrying out the medical billing process and training your staff. It wastes your time and resources, which can rather be spent on providing dedicated services to the patients.  
Eminence RCM eliminates the administrative tasks and takes over the burden of your in-house staff.  

Aligns the Process 

Your hospital billing services provider – Eminence RCM integrates the most advanced hospital medical billing techniques into your current billing system. We make sure that your data becomes standardized and accessible. This increases the efficiency of your medical billing process. 

Reduce Costs  

One of the best ways to cut down on the expenses is to cut down the expenses. When you are handling billing in-house, you need to pay wages, employee benefits, other costs, etc. With Eminence RCM, you can eliminate all these costs and get a healthier revenue system.

Better and Accurate Billing Procedures 

When you outsource your hospital billing services to the experts of Eminence RCM, you will be getting specialized billing solutions. The team is trained with the best and updated coding techniques. Everyone is regularly updated with the evolving rules and regulations. Proper knowledge eliminates the chances of errors and denied claims to the minimum
Therefore, it is a great idea to outsource your hospital billing services to the experts of Eminence RCM.