The medical billing industry has been around since dawn, but it’s still adjusting to the changing landscape. The medical billing industry is highly competitive, and it cannot be easy to succeed. Many factors affect the success of your medical billing company. But if you know what to expect from this tumultuous historical period, you can be prepared for any challenges ahead.
The History And Challenges of Medical Billing
Medical billing for the healthcare industry is complex, and some challenges are present in the field. The challenges will not deter medical billers from their work; instead, they will find innovative ways to develop new strategies and overcome them. The history of medical billing has been in existence since the 1800s. It is a process of collecting payment for services delivered by healthcare providers. Medical Billers are responsible for maintaining up-to-date account information with insurance companies and patients’ health plans and ensuring that every claim submitted to insurance carriers has correct information.
A career in medical billing is an excellent choice if you want to provide quality service while being creative, detail-oriented, and dependable. It requires people who are confident, compassionate, persistent, flexible with time management skills, well informed of the healthcare system, customer service oriented, and have strong determination skills – all these are qualities that make a good medical biller.
The medical billing agency is a company that helps healthcare providers to generate revenue. Medical billing agencies are using several approaches to make sure that the doctors or clinics are getting paid by the insurance companies.
Medical billers are mainly responsible for the following tasks:
- Answering questions from physicians and staff members
- Applying coding systems to patient’s data and verifying the accuracy of the claim
- Handling insurance strategies, such as coverage verification
- Collecting and analyzing data such as demographic information, financial information, or clinical data
- Working with other departments to process claims
Medical Billing Industry Challenges In 2023
To help you understand what challenges you may face as an entrepreneur, we have listed some of them below:
Healthcare security is critical for all healthcare providers, whether you’re managing an inpatient or outpatient facility. The threats posed by hackers and data breaches have become increasingly widespread, causing countless headaches for the medical billing industry. Many healthcare organizations are investing in appropriate protections to protect sensitive patient information. Simple actions such as adopting multi-factor identification and robust firewalls help to decrease hackers’ success. Third-party patient engagement providers must also have the HITRUST Certification, which integrates numerous safeguards from HIPPA, COBIT, HITECH, PCI, and other regulations. Vendors who obtain this certification are far less vulnerable to ransomware threats or data breaches.
Technology adoption will be a challenge for the medical billing industry in 2023. The speed at which new technology can be adopted, tested and implemented is critical to meeting the needs of today’s healthcare providers and patients. In addition to being cost-effective and time-efficient, technology must also be effective for it to be adopted by your organization. The question of whether your present systems are sufficient is tough to answer because transitioning to a new EHR or practice management (PM) system can be a daunting task involving practically every aspect of the company.
Even for medical groups looking to upgrade or keep growing than their current technology can manage, ongoing supply chain concerns limit the availability of new electronic equipment, and experts predict that shortages will remain through 2023.
Even though more healthcare data is being produced, it is dispersed across numerous parties and platforms, including payers, providers, and patients. To improve the patient experience, clinicians cannot rely on a single “source of truth.” For example, when patients change insurance plans or healthcare providers, most medical practices rely on patient self-reporting to reconstruct their records. As a result, not all information is effectively transported, making it challenging to harness the potential of data and develop precise insights.
Furthermore, healthcare data comes from a range of sources in a variety of formats. There currently needs to be a system or technological infrastructure that can retrieve, store, and analyze data from several sources at scale. To fully leverage all patient data from several sources, healthcare companies must use non-relational information systems, which allow data from multiple sources to be used, even if the datasets are in various formats.
An aging population will lead to more medical bills. As the population ages, more people will have chronic conditions such as diabetes and hypertension that require expensive treatment. This can be problematic for insurers because of their limited resources and high administrative costs. The elderly also tend to use more services than younger individuals do—which means they have higher healthcare costs than other age groups when it comes time to pay back their medical bills.
In addition, an aging population means many people who were previously healthy may now be dealing with multiple chronic conditions at once (such as heart disease). This makes them even more susceptible to expensive treatments requiring long-term management rather than quick fixes like annual checkups or flu shots.
Effective Payment Model
Financial incentives are increasingly being determined based on patient results rather than service volume to reduce costs while improving the service quality. Payers and patients request new pricing models that enable care providers to integrate services and promote preventative care, such as bundled payments, distribution to patient-oriented care providers, worldwide payments, and shared profits. However, adopting these new models and tracking the operations within the existing systems present numerous obstacles. Further measures must be defined to monitor performance and ROI.
Healthcare practitioners should keep a close eye on the progression of this phenomenon. Listen to early adopters and influential organizations (like Medicaid) testing and fine-tuning these new payment structures to learn how to cut costs and enhance patient outcomes while remaining profitable.
Even though many patients returned to in-office healthcare visits in 2022 as COVID-related isolation became less required, telemedicine use remains higher than before the pandemic. In reality, the telehealth industry was valued at $49.9 billion in 2019, but it is expected to grow to $194.1 billion by 2023 and then to $459.8 billion by 2030. However, the telehealth sector continues to confront significant challenges in 2023, such as slowing digital health investment and an uncertain regulatory future.
Finding qualified, dependable employees to support our doctors in treating patients continues to be a critical priority for many medical group leaders. Independent practices are finding it challenging to compete with new-hire incentives in markets where they deal with hospitals and health systems. Good employees are hard to locate and afford – inflation and wages are rising while reimbursement is falling. At the same time, those practice leaders are increasingly conscious of the impact on long-term employees. Staff that have stayed throughout the pandemic are pretty burned out. Rapid turnover aggravates the problem. According to one recent poll, 4 in 10 medical organizations had a physician quit or retire early in 2022 owing to burnout, and administrators are feeling the pressure: 80% of healthcare management reported an increase in stress or burnout in 2023.
The impact of the staffing difficulties and increasing expenses typically cannot be solved by restricting budgetary belts. Instead, expanding existing revenue sources and creating new ones will go a long way toward assisting medical groups that disclose difficulty collecting on older patient balances and receiving payment from patients covered by high-deductible health plans (HDHPs).
Many practice leaders informed MGMA that prior authorizations, claim denials, and long wait times for appeals impede their ability to provide timely care and be reimbursed for it. Others have stated that they are changing their hiring plans for the future year in response to projected Medicare reimbursement reduction and stagnant commercial payer rates. If revenue were higher, we’d be able to offset the cost of increasing spending, labor, and technology, as one practice leader explained. However, without revenue, we will be unable to maintain the medical billing industry in 2023.
As you can see from this list, there are a lot of challenges that the medical billing industry is going to face in 2023. By being aware of these trends and planning for them now instead of reacting when they happen – which could put your business at risk – you’ll be able to keep your customers happy while ensuring that their health insurance premiums stay low!