Medical Billing Challenges And Solutions You Need to Know

Medical Billing Challenges And Solutions You Need to Know
The end of 2023 may be coming soon, but billing changes regarding the CMS Physician Fee Schedule and the CPT E/M codes remain. It’s vital that you can navigate through the complexity of medical billing, which includes multifaceted coding systems, insurance policies, reimbursement rules, and compliance regulations. Now is the time to gain control over your bottom line before it’s too late – before you’ve been hit with claim denials, delayed payments, and financial losses.

At Synapse, we believe that time is precious and it shouldn’t be wasted on ineffective billing processes. We present solutions to your practice’s pain points and provide you with the relevant data to ensure you won’t repeat past errors. This blog will discuss the top 3 medical billing challenges and their solutions.

Top 3 Medical Billing Challenges in 2023

Documentation and Coding Errors

ABC News reported that hospital bills exceeding $10,000 were found to have an average error of $1,300 according to Equifax audit, a credit agency firm. It is commonly caused by human error, which can be reduced when the following certain solutions are in place.

For instance, coding errors and incorrect billing occur when a physician’s note lacks detailed patient information. The solution is simple: Engage the team of coders and staff members in comprehensive training programs. Make sure you can test whether they have a strong understanding of accurate documentation and coding practices.

Another example would be an incorrect diagnosis code since it does not match the documented symptoms. Your solution is a multi-level quality check system before the coded bill proceeds to the billing department. At Synapse, not only do we have a team of certified coders on staff but we help our clients invest in modern tech solutions such as EHR and coding software to automate processes and stay updated with the latest guidelines.

Compliance with Regulatory Requirements

Did you know that the ICD 10 coding system was introduced in the US in 2015? This new coding system comprised 68,000 codes compared to 13,000 codes in ICD-9. Adjusting to a tremendous change can take a toll on your practice’s staff and cash flow. Our advice is to establish compliance teams, engage with payers, invest in training, leverage technology, conduct audits, and seek external expertise.

Most importantly, managing patient data securely can keep you away from difficult legal situations. Prioritize staff training for HIPAA compliance and implement strict access controls. You may also perform periodic risk assessments to implement patient data security effectively. In the case of insurance coverage policies, you need to have a point of contact with insurance companies, so it’s wiser to have specific staff members to double-check fine details. Claim denial management is inherently complicated, so having Synapse as your billing partner can help you stay updated with the right people at the right time.

Insurance Claim Denials and Rejections

According to Equifax, poor billing practices lead to approximately $125 billion lost annually by doctors in the United States. Now, hospitals face numerous challenges with inaccurate or incomplete patient information, such as misspelled names, and incorrect insurance policy numbers, etc. These errors may be brought by complex insurance policies and outdated patient data. What can we do about it? By making the initial stage of patient registration foolproof, you can ensure that the front office verification is immediately error-free. Additionally, implement robust claim reviews and auditing processes, so you can identify and address potential issues before submitting claims.

Overcoming Billing Issues with Synapse

The evolving nature of the medical billing landscape is challenging on its own, but it would be more difficult if you were not equipped with the right team to handle all your issues. Our team of expert billers and coders empowers healthcare organizations’ financial stability and success. They stay up-to-date with industry trends, regulatory changes, and technological advancements. Embracing a culture of continuous learning and innovation is what we have delivered for over 30 years. So if you’re looking to improve your revenue cycle management (RCM) process, Synapse is just one click away. Contact us today or email us at