5 Things Capable of Slowing Down Medical Reimbursements

The U.S. healthcare system relies on a somewhat complex billing and payment system. For better or worse, the system is designed to bridge the gap between patients, providers, and payers. When everything works as it should, reimbursements from payers to providers flow freely. But if just one thing goes wrong, reimbursements can be delayed. If you are in the medical billing industry, you know all too well how this happens.

The medical billing system is comprised of so many layers that it doesn't take much to gum up the works. From different coding manuals to unclear information given by providers, there are plenty of mistakes just waiting to be made. Every mistake represents another opportunity to slow down insurance company reimbursements.

To illustrate the point more clearly, here are five things that tend to delay reimbursements:

1. Billing Errors

Payers only process clean claims – which is to say claims determined to be error free. Just one billing error can throw everything off. For example, a seemingly small mistake can result in an incorrect A/R calculation that ultimately leaves the provider waiting even longer for reimbursement.

Posting errors can be caused by software glitches, hardware glitches, and human input. The good news is that such errors are easily corrected once discovered.

2. Incorrect Billing Codes

It should be obvious that incorrect medical billing codes slow down reimbursements. Payers have to sort through claims in order to reconcile codes that don't make sense. That may mean contacting the provider for more information. But it could also mean rejecting claims outright. Claim rejection is a big problem that can cost providers a ton of money.

3. Improper or Incomplete Training

Medical coders are trained professionals who are supposed to know medical billing codes and software tools inside and out. But as with any job, improper training puts a coding specialist at a decided disadvantage. The same goes for incomplete training.

Medical billing accuracy is directly tied to training. More importantly, both codes and requirements are constantly changing. It's vital that coders stay current with their training.

4. Inadequate Billing Staff

Medical billing codes are complex enough without having to worry about pushing through enough work to keep the boss happy. Throw in staff shortages and you have a recipe for rejected or delayed claims. The reason is simple: billing specialists forced to rush through their work to meet an artificial quota are more likely to suffer from accuracy issues.

Payers demand accuracy. They rely on accurate coding to determine how much to pay on each bill. Payers also know that accuracy suffers when there are not enough coding specialists to handle billing in a timely manner.

5. Repeated Mistakes

The last item on the list is often a culmination of the other four. Here it is – repeated mistakes by the billing department. Repeated mistakes are an open door to all sorts of problems including takebacks and fraud charges. They can open a can of worms that require internal audits and other corrective actions. All the problems created by repeated mistakes slow down reimbursements at minimum. They can bring reimbursements to a halt if they are serious enough.

As a medical coder, the providers you work for are expecting reimbursements in a timely manner. Do not let the work you do contribute to any potential delay. Make sure you are using accurate data. Make sure you understand each bill before you begin coding it. And finally, check and double check your work before submitting it.

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