The new calendar year often brings a slew of challenges for healthcare providers, especially when it comes to billing. The start of the year marks the reset of patients’ annual deductibles, which can result in an increased financial burden for both patients and providers.
This article aims to offer practical solutions to some of the most common billing challenges that healthcare providers face during this period.
Understanding the Challenges
Before we delve into the solutions, it’s essential to understand the challenges. One of the key issues is insurance reimbursements, which have become crucial for sustaining medical practices and expanding services [1].
With the advent of new rules and regulations, such as the separate add-on payment for healthcare common procedure coding system (HCPCS) which is set to be implemented by CMS from January 1, 2024 [2], the complexity of billing processes will increase.
Another significant challenge is the decrease in Medicare payments to home health agencies, estimated at 2.2% in the calendar year 2024 [3]. This cut could seriously impact the financial stability of these institutions.
Further, commercial health plans often delay payments and deny medically necessary care, adding to the financial strain on healthcare providers [4].
Practical Steps to Overcome Billing Challenges
- Seek Pre-authorization
One effective strategy to decrease claims denials is to seek pre-authorization before providing services. This involves getting approval from the patient’s insurance company for certain procedures or medications.
By doing so, you can ensure that the service is covered under the patient’s health plan, thereby reducing the risk of claim denials.
- Check Eligibility Regularly
Regularly checking patients’ insurance eligibility can help prevent claim denials or delays in payment. This can be done before each appointment to ensure that the patient’s insurance coverage is still active and confirm the services covered under their plan.
- Accurate Coding
Accurate coding is crucial to avoid claim denials or underpayments. With the implementation of the separate add-on payment for HCPCS [2], it becomes even more important to ensure accurate and up-to-date coding practices. Regular training for your billing staff on the latest coding standards and updates can help maintain accuracy.
- Prepare for Deductibles Reset
The start of a new calendar year signifies the reset of deductibles. During this time, patients are often reluctant to seek non-emergency medical care due to high out-of-pocket costs. To mitigate this, healthcare providers can educate patients about the importance of regular health checks and the potential long-term cost savings of preventative care.
Final Thoughts
Conquer the billing hurdles of the new year with a proactive approach!
At Reliance, we understand the challenges you face and can help you overcome them. By implementing effective strategies like pre-authorizations, eligibility checks, and accurate coding, we can help you minimize the impact of deductible resets.
Take control of patient financial responsibility, streamline your collections process, and create stable and positive relationships. Contact us at 717-740-2622 or email: info@reliancembs.com to discover how we can collaborate and transform your practice’s financial experience.
With Reliance® – Medical Billing Made Simple®.
References:
[1] Hematology Advisor – “Insurance Reimbursement Challenges for Physicians”
[2] CMS – “Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule”
[3] Nelson Mulluns – “Payment Cuts and Program Changes: CMS Issues Calendar Year 2024 Home Health Prospective Payment System Proposed Rule”
[4] American Hospital Association (AHA) – “Addressing Commercial Health Plan Challenges to Ensure Fair Coverage for Patients and Providers”
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