How difficult can medical claim filing and payment posting be?


Hospitals, healthcare organizations and dentists have long been occupied with the issue of medical filing. The process of medical claim filing is overtly complex, requiring paper work, filing and adjudication. Moreover, with the introduction of new reforms in the system every other day, which is ironically meant to save time and energy of the physician, is a reason for increasing problems until physicians manage to successfully make the required changes.

Hence more documentation, additional reform requisites requires more administrative staff. At times, the ratio of staff dedicated to handle the paperwork to doctors can even be as high as 1:12. Organizations can end up making 19 copies for every document, for which they have to spend $20 in labor to file these documents. However, 1 in every 20 documents gets lost due to glitches in administration. The increasing documentation requires attention and efforts from physicians as well, which makes it difficult for them to concentrate on what they are supposed to be. Hence, it also leads to the shortage of doctors in the healthcare organizations.

With the electronic filing of the claims made mandatory with HIPAA, it will benefit physicians due to lesser paperwork, but physicians now need to update their systems with the right software to file claims electronically. Also it has become crucial for the physicians and coders to be trained in ICD 10 for future filing of claims. Moreover recently in an event of aberration, the claim has a high chance of being rejected and the physician has to repeat the process all over again. This invariably leads to time consumption and cost delays. Insurance payers recently have become increasingly stringent about the course of claims, thus directly afflicting the physicians and their revenue procurement.

Hiring a trained and professional medical biller and coders services can provide a breakthrough for the physicians from all of these problems. The professional medical biller and coder possesses sound knowledge about the rules and regulations regarding medical coding including constantly changing updates, regulations and compliance. Issues like claims denial, medical necessity, bundling issues and charge capture can be handled by them efficiently.

Reforms like HIPAA which are actually designed to protect the privacy can actually be a reason for major concern among the healthcare organizations. They require claims to be filed only electronically, which is undoubtedly a fast method, but besides challenges like converting to system of electronic payments, there are times when the electronic claims get rejected because of lack of petty things like right payer number, provider’s pin number etc. These issues, although seem to be minor, may end up in over extended deadlines and a loss of revenue to the organization. In this scenario, presence of a specialized billing service may help avoid such problems in the organization.

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