How Can Billing Companies Overcome Their Worst Nightmare?
Medical Billing since its inception has both equal parts of Healthcare providers and insurance companies. For Healthcare providers it’s more in the part of reimbursement while for the insurance companies it’s holding their profits. As the Billing became more and more complex with an inclusion of other regulations the need skilled billers and coders was felt in the total healthcare sector. Mr. Lee. B an Operations Managers at MedicalBillersandCoders.com (MBC) from last 20 years has strongly commented about the changing structure of health care sector,” The early concept of fee-for-service (FFS) had given a sense of security and understanding for a physician wherein the revenue generated was dependent on the factornumber patients. Now as the shift started towards providing healthcare for all it became a business for insurance companies to earn through premiums. Now we have value-based payment model were in a doctor will be judged on different factors and then will be paid accordingly. The need of a team of coders and billers is looking to peak with more compliance issues coming-up.” Medical Billing companies currently act as a bridge between the payers, and the service providers any glitch in the two parts indirectly affect our coding and billing process. This has even got some worst nightmare for the medical billing and coding company. 1. Lack of Transparency from Insurance Companies Whenever a claim is submitted, there is always a 50 to 50 percent chance that the medical claim might be rejected or accepted. Thus, in turn, when the claim is rejected the reasons for the rejection mentioned in the Explanation of Benefits (EOB) are coded in words understandable eats up more time for a biller to prepare a reclaim or re-appeal. For simple coder and biller to solve the problem of revenue management will cripple down your RCM process. The need of channelized transparency between Medical Billing and the insurance company will promote the health care billing system.
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