Pursuing a successful career in the medical field is difficult. But the obstacles are even bigger when you work as a medical biller and coder. It would help if you connected with the patient, the doctors, the insurance company, and other organizations. You are also expected to know the procedures, laws, and regulations governing the healthcare industry.
But, just like with other professions, there are many challenges faced in medical billing and coding. Also, every obstacle you face helps build your expertise. So, let us explore some medical billing challenges and how to overcome them.
Why is Medical Billing and Coding Important?
Medical billing and coding are significant procedures for the running of hospitals. Hospitals depend on insurance providers and medical programs for funding.
Insurance firms make their yields by charging those who have policies. The buy-ins enable the insurance service providers to cover most healthcare costs of policyholders, liable for the policy. So, most funds come in from reimbursements rather than from consumers.
That is why it is incredibly significant for medical billing and coding to be executed precisely. The specific job of a medical biller and coder helps make the entire functioning of the medical and bill payment smooth and easy. The critical role they play in hospitals and medical offices is handling patient billing details.
Medical billing and coding experts have multiple administrative duties, such as establishing and maintaining records and databases. They use a different system to help organize patient information for multiple purposes. Some instances are details for registration, treatment history and insurance reimbursements.
What are the Common Problems in Medical Billing and Coding?
Some of the challenges faced in medical billing and coding are:
1. Medical Privacy Laws Protect Medical Information
Medical billing and coding specialists must follow all the rules, regulations and policies like HIPAA Privacy & HITECH Act when dealing with sensitive data like medical details. All personnel need to follow the national standards to protect patients’ rights.
As these laws regulate information, medical billing experts also need to understand the legal aspect of their work. They need to maintain complete confidentiality when it comes to patient privacy. This can be quite tiresome.
2. Understanding the Medical Billing and Coding System
There are standards that students learn in a medical coding and billing program. Some of the most common ones are EHR and EMR Software systems. Even though they are digital versions of patient health details, they have some differences. The EMR or Electronic Medical Record is like a patient’s chart from a healthcare facility. In contrast, EHR or Electronic Health Record is a larger picture of the patient’s health from multiple sources.
Just like other software, EHR and EMR have their weaknesses. Both systems need some time to learn and depend on third-party technical support. This is necessary as regular health updates are required to keep the system running smoothly. Another major drawback of using this software is the possibility of a data breach. Although they might be less strenuous, they can lead to serious consequences for patients and professionals.
3. Errors when Extracting Data with Medical Records
Integrating the newest technology is one of the biggest challenges of a medical billing and coding specialist. Slowly automated workflows decrease the workload, but some tasks must be done manually. Because of the sensitivity of data, having proper concentration levels is highly important. In any case, human errors must always be considered, and medical billing and coding specialists must work towards preventing them.
4. Technical Updates for Medical Billing and Coding
As a medical biller, you must understand the globally accepted medical codes used in ICD and CPT. The ICD or International Classification of Diseases (ICD) 10 codes are international standards for defining and reporting disease and health conditions. At the same time, CPT or Current Procedural Technology are coded to help improve the accuracy of medical codes and services.
But these codes keep changing and evolving very often. Every year they release a list of new, amended, or deleted codes that a medical biller or coder needs to stay on top of.
5. Medical Billing and Coding have Third Parties Involved
Medical billing and coding specialists must create synergy between the parties involved. This includes communicating with government agencies, health maintenance organizations, insurance companies, hospitals or institutions, and employers.
Following all protocols is inevitably a part of the job. But to do the job, you must be polite, patient, and persistent. So, sometimes the job can be tedious and exhausting. If you are having a rough or bad day, you still need to put a smile on your face and keep moving forward.
6. Medical Billing and Coding during the Pandemic
The billing and coding sector has flexible and remote working hours, but with the recent Pandemic, they witnessed a surge in workload. Following the COVID-19 outbreak, new billing standards were established, with work from home becoming the new normal, so billing and coding specialists must be ready to adapt to any situation. This was quite challenging, especially when managing a household during the Pandemic.
7. Renewing Medical Billing and Coding Certification
Like other health professionals, medical billers must renew their certifications every few years. AHIMA, NCCT, and NHA all need their members to renew their certifications by completing their education and paying a renewal fee. Despite the commitment, keeping updated certificates ensures you can keep steady employment.
Key Takeaways
Providing patients with the best care is one of the main oaths that healthcare providers take. Similarly, for billing and coding experts, unless they have the right medical billing and coding training, it might be difficult for them to perform their job and help serve the patients.
Now that things are settling down during the Pandemic, the billing environment is slowly changing, with outsourcing becoming the new normal. More and more healthcare sectors are outsourcing their billing department to improve operations.
So, as a billing and coding expert, there are multiple issues you might face, but the pros outweigh the cons. Ultimately, it is all about helping patients get the best medical service.
