Biggest Barriers to Reimbursement

Reimbursement is always a hot topic of conversation in the healthcare industry as organizations are continually trying to figure out how to streamline the all-important revenue cycle management process. Often many of the conversations center around the difficulties practices face when trying to receive reimbursement for care. Let’s talk about this process and some of the biggest barriers standing in the way of reimbursement and how you can get past them.

What is healthcare reimbursement?

The healthcare industry is unique compared to other industries in that services are paid for after they are rendered. This is where the term “healthcare reimbursement” comes from. Essentially, healthcare reimbursement refers to the payment providers and facilities receive for the medical services they render.

The reimbursement process for healthcare is lengthy and requires multiple steps depending upon who bears payment responsibility, and there are numerous opportunities for error along the way. Often, at least part of a patient’s care cost is covered by a private insurance payer or a government payer such as Medicare or Medicaid. Receiving payment from these entities requires the submission of detailed claims according to the specifications of each payer. Depending on the patient’s insurance coverage, they may be responsible for some or all of the cost. While issuing invoices to patients is far less complicated than payer claims submission, collecting patient payments can be difficult for myriad of reasons. No matter the situation, healthcare reimbursement is complex and time-consuming and reimbursement in full is never guaranteed.

Why is healthcare reimbursement important?

Healthcare reimbursement is important for a couple of very simple reasons. First, medical practices are businesses and just like any other business, they require revenue to cover costs and be able to continue providing care. Additionally, keeping healthcare costs manageable for all patients depends on providers being adequately reimbursed. When providers fail to receive payment, this often results in an increase in care costs overall, affecting everyone.

What are the biggest barriers to reimbursement?

While there are several slip ups that can get in the way of providers receiving full reimbursement, the following four are some of the biggest:

1. Payment delays caused by inadequate patient information capture. Essentially, the RCM process begins when the patient schedules their appointment. At this point, the front office staff is responsible for collecting the patient’s demographic and insurance information. It’s imperative this information is collected accurately as payers will reject claims for any inaccurate information.
2. Collections issues caused by failure to communicate patient responsibility. Patients today bear a greater responsibility for their care cost than ever before. While they are obviously aware of this, sometimes that responsibility is greater than they could have imagined. Other times they were under the impression that their care would be covered and are instead met with a surprise bill. These surprise bills often go unpaid. This is why cost estimation and communication are so important so that patients are able to understand and plan for their costs.
3. Heavy administrative burdens caused by a manual claims management process. Managing medical claims is incredibly complex. When practices perform this process manually, it’s very easy for tasks to slip through the cracks. Additionally, it’s unnecessarily difficult and time-consuming. One of the best things practices can do to streamline their RCM process is to bring in at least some level of automation in order to ease this administrative burden.
4. Inaccurate coding. Claims that are not coded correctly lead to denials. Inaccurate coding most often begins with inaccurate or inadequate documentation. Providers and their support staff must be sure to correctly document everything that happens during an encounter in order to enable billing staff to submit a correct claim that is unlikely to be denied.

Healthcare reimbursement is a challenging but necessary task in every medical practice. While there are barriers that can make receiving reimbursement in full difficult, they are not impossible to overcome, you just need the right tools. With this in mind, MicroMD Practice Management has been designed to streamline your practice’s RCM workflow from beginning to end. We’ve also packed our Solutions Center full of best-in-class vendors who can help you revolutionize your process toward healthcare reimbursement.

For more information about how MicroMD can help, visit micromd.com or call 1-800-624-8832.