Pulmonology is the branch of medicine that deals with ailments of the lungs and respiratory system. Also known as pulmonary medicine, this branch is a subspecialty of internal medicine. However, this doesn’t limit the scope of pulmonology. Pulmonary medicine is extensively employed, catering to numerous patients on a daily basis. It is inclusive of diagnosis and surgery of various disorders and ailments.
It is reasonable to say that pulmonologists are busy professionals and have minimal time for administrative processes. Apart from that, the process of medical billing is equally challenging and needs expert knowledge. The intricacies of pulmonary medical billing are the reason for interruptions in the workflow of operations. Another major impact is the mismanagement of the revenue cycle and reduction in reimbursements.
As healthcare providers find it hard to navigate through medical billing, a simple solution to this issue is outsourcing pulmonary medical billing services. It is a beneficent method that contributes to productive revenue cycle management by effectively handling critical pulmonology medical billing.
Tackling the challenges in pulmonology medical billing is vital to empower your practice and make the performance robust. However, to achieve a strong financial posture, you must understand the challenges. This will ease the hassle and strengthen the revenue cycle management and practice management.
Let’s begin by learning about the challenges
Challenges of Pulmonary Medical Billing
Knowing the complexities gives proper insight into how to overcome them and improve financial performance. The following are the common challenges of pulmonology medical billing:
Coding and Documentation
The process of medical billing is all about submitting the claims and coding is a significant part of the process. It is affected by numerous factors such as errors in documentation and ever-evolving regulations. Errors and mistakes while filing the claims lead to disruptions that result in denials and rejections. The consequence of this is revenue leakage or delay in collections.
The specialty of pulmonology is intricate and errors in coding and documentation can prevent your practice from achieving desired revenue. Coding that matches the pulmonology procedures is vital to ensure timely and complete reimbursement. Details such as diagnostic tests, interventional procedures, and respiratory therapy have different codes. Such details can be overlooked in a thorough medical billing process.
If the details regarding the treatment are recorded properly then it eliminates the possibility of coding errors. Care is needed in the case of both coding and documentation. Apart from that, you must prevent over or under-coding.
Claim Denials and Revenue Delays
Claim denials and revenue delays widely occur because the practice is unable to fulfill the requirements of the insurance company. The need to meet guidelines set by the insurance company becomes a hassle. Many times, healthcare providers are unaware of the mistakes and drawbacks.
The reason can be anything ranging from coding error, and missing information to late submission of claims. In the case of pulmonology, the factors that cause denials and delays are incorrect documentation, treatment without medical necessity, coding errors, and inability to satisfy specific requirements. Claim denials can prove to be unfavorable for the pulmonology practice as there is either a loss or a delay in receiving reimbursement.
Frequently Changing Rule and Guidelines
Another challenge is frequently changing and evolving medical billing guidelines and regulations. Healthcare providers have limited control over this situation as they cannot change the guidelines. They can only work with the regulations and make a way around the situation. For this, they need to stay current with regulations.
The coding and billing guidelines are issued by CMS (Centers for Medicare and Medicaid Services). There are frequent alterations in the coding guidelines, documentation requirements, and revenue policies. All these changes are the reason for pulmonology practice to make mistakes and miss out on some of the details. Here, mistakes not only lead to revenue loss but can also lead to legal issues.
It is the responsibility of healthcare providers to make necessary adjustments in their efforts and tackle this challenge efficiently. Addressing this issue will have positive results and help the practice in achieving maximum reimbursement.
The challenges in pulmonary medical billing are burdensome for healthcare providers. There is a need for proactive measures to solve these issues. Managing everything is not one person’s job. Here, medical billing services can tactfully handle the complexities with professional solutions.
There are plenty of reasons to opt for pulmonary medical billing services and they are:
Reasons to Outsource Pulmonary Medical Billing Services
Proficiency in Specialty
Medical billing services hold specialty-specific expertise where they are well equipped with the coding requirements of pulmonology medical billing. They are aware of the consequences of not maintaining accuracy in coding and documentation. Experience and immense knowledge of the medical billing system let them know every detail of the process. They help at every step of the medical billing with effective solutions, specific to the specialty of pulmonology. With all this, a smooth workflow and optimum revenue are guaranteed.
Reduction in Documentation and Coding Errors
Coding errors are one of the major reasons for claim denials and reimbursement loss. However, medical billing services are familiar with the coding systems and guidelines. Their deep insight into CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) codes helps in achieving accuracy in pulmonology billing.
A medical billing company stays up to date with the latest changes in CPT and ICD codes. It offers services such as regular review of the guidelines to streamline the process and avoid errors. Along with that, most of the billing process is done electronically, this eliminates the possibility of manual errors that usually occur during documentation. It maintains reliability by recording details about patient visits, their symptoms, and number of visits. Then, most specific codes are attributed to carry on with claim filing. As a result, the healthcare practice experiences an improvement in the administrative process and revenue.
Knowledge About Changing Trends
A medical billing company understands the value of being informed about the recent trends in this continuously changing world. It is also a key factor in determining accuracy and mitigating errors. Medical billing services providers ensure that they know the changes in guidelines and regulations and incorporate the changes in the process for better billing outcomes.
Improvement in Cash Flow and Revenue
Managing an in-house medical billing team can be more challenging in terms of how expensive it can be. It poses the need to invest in infrastructure and provide salaries to the staff. It also increases human errors that result in loss of revenue. All this adds up and can become extravagant.
However, medical billing services are a solution to this. All the expenses towards in-house medical billing are shifted to a single investment in medical billing services. Together with that, there is an overall improvement in claim submission and revenue generation. All this contributes to the upgradation in revenue cycle management. With zero billing interruptions, pulmonary billing services increase cash flow and improve revenue.
Transparency in Services
Medical billing services offer an array of services, one of which is transparency. They are open and honest regarding their services, charges, and position of the practice. As a medical billing company provides services, it ensures that you know everything about the process. Reliable outsourcing companies give complete details including additional and hidden charges. As a healthcare provider, you get efficient services. Companies also give insights into the financial performance of healthcare practices.
Increased Focus on Patient Care
As pulmonary billing services take over the process of medical billing, healthcare providers get more time to spend on patient care. They can utilize this time to focus on improving the quality of patient care. The assistance of medical billing services not only reduces the administrative burden but also eradicates the stressful environment. This is a win-win situation for both healthcare providers and patients.
Patient Satisfaction
Another vital reason to choose medical billing companies is the satisfaction of patients. It is an overall experience where benefits are for both healthcare providers and patients. Outsourcing makes the billing effortless and following through the steps becomes seamless. On one hand, it reduces a healthcare provider’s time and on the other hand, patients don’t have to wait for longer. The ease in every step improves the patient's experience, which is the reason for their satisfaction. As healthcare providers devote more time to patient care, patients are also satisfied with the healthcare services.
Bottom Line
It is clear that challenges in pulmonary medical billing are the prime reason for a downward trend in reimbursement. However, every difficulty comes with a solution and here the solution is an outsourcing partner. A medical billing partner understands intricacies like coding errors and documentation issues, while being aware of the need to stay current and responsive. When a healthcare provider joins hands with a pulmonary billing partner, the outcomes are positive. Choosing an outsourcing partner can take some more of your time. Therefore, Unify Healthcare Services is here to reduce some more of your hassle.
Unify Healthcare Services is the leading medical billing services in USA. Our team of professionals is proficient in pulmonary medical billing. Our billers and coders are knowledgeable enough to handle even the minor nuances of pulmonology medical billing. We ensure robust support in enhancing management and improving revenue.
