Chances of a prompt service reimbursement is heavily dependent on coding accuracy, timely and accurate claims submission, follow-up on claims, among others. Each of these tasks have their own sets of challenges. For instance, the ongoing pandemic has triggered multiple changes in medical codebooks. For a private practitioner, it is an uphill task to keep track of these changes, implement them, process bills with accurate codes, and at the same time upkeep his/her medical care quality. On this note, here’s throwing light on some of the imposing physician medical billing services:
CPT Code Changes
Revised evaluation and management codes, CPT Code 99201 getting obsolete, eliminating physical and historical elements of code selection are some of the major code changes introduced last year. This burdened individual practices to educate themselves on the code reforms and apply those on claim documentation appropriately. Dealing with a surge of patients during the pandemic, physicians are not being able to keep up to these changes. These are reflected in erroneous claims documentation which are promptly getting rejected by insurers.
Last year, the American Medical Association introduced new codes 99202—99215 in the CMS medical record documentation guidelines. This change stated that coders will no longer consider an exam or medical history to choose a medical service. This brought about a lot of changes in electronic medical record keeping. It required physicians to recalibrate their existing electronic health record interfaces to adopt the new codes. Delay in doing so had resulted in billing errors which ultimately resulted in claim denials.
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The pandemic-induced mobility restrictions, health issues, and regular burnout have triggered employee attrition across many physicians’ offices. They are struggling hard to manage an influx of patients and executing administrative tasks at the same time. This is taking a toll on both the tasks. It takes over a month to find billers and coders with the right expertise. Meanwhile, accumulating unresolved claims are draining out physicians’ revenue pool.
Data Security Issue
Last year HIPAA implemented changes in data security rules to ensure patient data safety. The change mandated medical practices to inform patients about the ways their health information will be used. This created fresh complications for physicians who were exercising a free hand in using patient data. They used data to run predictive analytic models to forecast patients’ future health conditions.
The emergence of newer Covid 19 variants is expected to bring newer complexities in medical administrative tasks while turning medical care into a potential battlefield. The road ahead is rough for physicians who are juggling both medical care and complex billing tasks. In addition, individual practitioners do not have the required capital or time to invest into an in-house team to execute medical billing services. In such situations, outsourcing this service is the best bet. Physicians get the job done by experts within reasonable rates. Such experts take full ownership of the billing tasks and require minimum to no intervention from their clients.
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