After COVID-19, providers are now ready to provide excellent patient care through direct and virtual modes. Medical Billing has always offered unique medical billing challenges prior and post-pandemic. Due to the changed billing environment post-pandemic, this struggle to receive accurate reimbursement has become more real than ever. As a leading medical billing company, Medical Billers and Coders (MBC) witnessed these medical billing challenges and discussed the top 5 of them in this article.

Top 5 Medical Billing Challenges:

1. Increased Number of Denied Claims

With so much financial uncertainty during the pandemic, it’s obvious to have an increased number of denied and rejected claims. Due to changing healthcare environment, every payer is updating their billing policies and reimbursement guidelines quite frequently. If you are not staying on top of these changes it’s obvious to receive more claim denials. Payers are also updating procedures that require prior authorization. If you miss taking such prior authorizations, it’s difficult to revert the decision of the payer on the denied claim. The increased number of rejected claims is also affecting practices’ financial bottom line. On average, any practice receives 5 percent to 10 percent of claim rejections every year. These claims can wind up costing $12 – $25 each to correct. With so many people losing their jobs, losing employer-sponsored insurance, rejected claim number would is likely to rise.

2. Surprise Medical Billing

Another medical billing challenge faced by providers post-pandemic would state that are taking action against surprise medical billing. If you don’t have a qualified medical billing team who is providing accurate cost estimates prior to patient visits, then it would be difficult to collect reimbursement not covered by the payer. Under the No Surprises Act (NSA), patients are protected from financial liability beyond normal in-network cost-sharing when treated by an out-of-network provider for most types of emergency care and nonemergency care provided in an in-network facility. Providers and facilities are banned from billing patients to collect a higher amount. If you don’t have the resources to manage surprise billing, then it will take a deep dig at your monthly collections.

3. Lesser Telehealth Reimbursements

The COVID-19 pandemic boosted the acceptance of telehealth services in all areas of healthcare. Though telehealth/telemedicine has been accepted widely, receiving accurate reimbursement and its legislation has offered unique billing challenges to providers post-pandemic. Though some private payers and Medicaid programs announced payment parity for telehealth for the duration of the pandemic, low reimbursement for telehealth was viewed as a critical disincentive. Telehealth has been limited by geographic rules that govern medical licensing. Cross-state billing remains a challenge for physicians who are not part of an in-state health care network.

4. Patient Billing

As discussed earlier, the COVID-19 pandemic has led to a colossal recession, adversely affecting health insurance coverage. According to an Urban Institute report, over 2.9 million beneficiaries became uninsured by 2021 year-end due to job losses created by the pandemic. Additionally, millions more could stop availing employer-sponsored insurance coverage. This paradigm shift in insurance coverage would lead to significant changes in payer billing tactics and payer mix. The surging demand for high-deductible health plans has led care providers to shift their focus toward self-pay methods. Complete collection of patient collections would remain a challenge, considering more adoption of high deductibles plans.

5. Lack of Skilled Billing Experts

With so many updates in billing and coding for your medical specialty, you will need an expert medical billing team. You can’t expect your front desk personnel to efficiently handle medical billing for your practice. Prior pandemics with higher patient volume, practices were just submitting claims and not taking any follow-ups on denied or rejected claims. With a changed billing environment after the pandemic, you can’t afford to lose a single claim to get denied or rejected. Finding skilled billing and coding experts who know to bill for your medical specialty would ensure the financial suitability of your practice after the pandemic.

To Conclude

Providing superior patient care always has been a primary goal of healthcare providers. The COVID-19 pandemic made things challenging as providers are fighting on different fronts. As things are settling down after the pandemic, providers want to focus on patient care without the worry of insurance reimbursements. Some providers are efficiently adapting to this changed billing environment by outsourcing their billing operations to a medical billing company. More and more healthcare practices and organizations are allowing outsourcing partners to use their expertise and improve the way they operate. Together, both parties are driving better outcomes than singular efforts that have been so dominant in the past.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and coding services. Our medical specialty-wise billing and coding experts will ensure you will get accurately reimbursed for all delivered services. You can call us at: 888-357-3226 or drop an email at [email protected] to know more about our billing services.

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