Top 10 Challenges In Medical Billing Today

With healthcare costs at all-time highs, it’s no wonder that patients continue to struggle with paying their medical bills on time. According to a Kaiser Foundation study in 2015, over 4 in 10 families with medical bill problems report that it has a significant impact on their family.

As you can imagine, this issue dramatically impacts the way the medical billing industry works and the healthcare organizations that rely on that money each month to run a profitable practice and provide the proper care needed for each patient.

To better understand what the healthcare industry faces,  we will look at the top ten challenges in medical billing today.

Let’s get started!


Related Links: Learn more about Rainbird Healthcare

medical billing challenges

Late Medical Payments

Late medical payments can come from not only patients but also insurance companies.  Making sure that your organization receives payments on time can be one of the most demanding challenges to get through.  There are specific software companies out there that can help in this arena, but most healthcare organizations will always deal with late payments.  It comes with the territory, but how your company manages it makes the difference.

Filing Multiple Claims Simultaneously 

An efficient practice and smooth clinical workflow are vital in the healthcare industry.  This can get hampered because when specialty providers have to file multiple claims at once, it can get extremely frustrating and cumbersome.  Organizations may find themselves having to file hundreds of claims all at once.

If there isn’t a strong mass claim creation tool, the practice may have to file each one of these claims individually.  This can take an immense amount of time and energy from staff that should be focused on other things.

Similar errors occur while transmitting patient statements. There are solutions that can automate part of these processes so that a flag will be raised when duplicate bills are created for the same treatments.

Inefficient and Improper Coding Systems

One of the most common mistakes in the healthcare field is improperly coding medical claims, and these can break down any efficient organization and make workflow slower than necessary.  There are a few reasons why improper coding happens, including using outdated coding books, mismatching codes, missing codes, or billing CPT codes that don’t match the contract that you have with your insurance carrier.

You can also add overbilling and underbilling to the list.  These can happen by accident but have also fallen prey to fraudulent activity.  Always look for a medical facility solution that encompasses coding automation that’s updated and reflects the newest coding requirements.

Making it easy for your staff to look up diagnosis codes is paramount for a well-functioning practice. You can do this by using software that can list codes specific to each medical insurance carrier so that your staff has little room for error.

Claim Denials

Denied claims happen far too often and can be frustrating to providers.  This happens most of the time because of the ever-changing medical billing codes in different parts of the healthcare field.  It makes it challenging to stay up to date and on track to reach your organization’s goals.

There are tools that can help providers increase the accuracy of their transmitted claims and safeguard their bottom line through software management adjustments.

Lost Revenue 

All businesses are aware of the revenue lost due to mistakes.  In the healthcare industry, the fear is just the same.  When these losses in revenue occur due to fundamental errors, it can be frustrating.  Having the necessary tools to help diminish these mistakes can help reach the provider’s overall financial goals.

Missing Authorization or Referral

There are a variety of medical plans, and some of them require that patients get a referral from another primary care doctor before the patient can use your services. After obtaining a referral there are multiple procedures that require a prior authorization

It’s essential to make sure your staff knows about these referral and prior authorization requirements, as well as the patient needs to understand that if these are missing, their claim will get denied.

Accessible Payment Options 

We live in an era where many different payment options are available; therefore, there should never be a problem when someone wants to buy or pay for something.  Believe it or not, some medical software still makes it difficult for patients to pay their bills online or offer fewer payment options.

If this sounds like your organization, it will cause you to see an increase in late payments into the practice.  If you can provide as many payment options as possible to your patients, you will have a much easier time collecting payments on time.

Informed Patients 

Communicating with your patients and keeping them up to date and informed can be challenging.  The more your patients know about the balance they owe, the payment methods they can use, and various payment plans, the more likely they will make their payments or set up a payment plan.

Having quality patient management billing software can help your organization collect patients quicker and more efficiently.

Modern and Efficient Medical Billing Software 

There are several customizable medical billing software companies out there that can positively affect your organization.  Look for software companies that provide customizable solutions and don’t claim to be the one-size-fits-all type of software.



Having the most efficient medical billing procedures is vital to maintaining a profitable and well-functioning practice.  Finding a customizable medical billing software program to help your organization will increase workflow and revenue and increase patient satisfaction in the meantime.

To learn more about our 180-day guarantee, get in touch with one of our professionals today!


Related Links: Learn how Rainbird’s approach to medical billing issues is helping to increase profits.

Leave a Reply

Get in Touch

Do you have questions about how RainBird Heathcare can help your practice/hospital?