Why is Medical Billing so Complicated? - BillPro (2024)

Billing is quite simple—you just take note of all the items or services purchased and their corresponding prices. Sum everything up, and you’ve got the bill.

However, this is not the case with medical billing. It is much more complicated than simple lists and prices.

Why is medical billing hard?

Why is Billing Complicated?

Basic business billing involves a buyer and seller or service provider and client.

Medical billing is more complex because there is the healthcare provider, patient, and their insurance company.

What is Medical Billing?

Medical billing in the U.S. goes beyond calculating healthcare procedures and treatments. It also involves processing healthcare claims that will be forwarded to insurance companies.

As of 2002, more than 92% of people in the U.S. are insured. That’s a lot of claims to be processed. Medical billers and coders have a huge responsibility to ensure that patients’ claims are reimbursed correctly.

Healthcare services are translated into billable claims. Knowledgeable medical billers and coders process the claims so medical billing issues will not arise and delay refunds. Worse, refunds may be denied or rejected.

Medical billing also incorporates various codes designed to standardize terminology in the healthcare industry. They add to the complexity of the process. It is also why a career in medical billing and coding requires a lot of study, training, and continuing certifications.

The right skills and knowledge will make medical billing and coding a bit easier for all parties concerned.

Is Medical Billing and Coding Difficult?

To those who know little about it, medical billing and coding may be almost incomprehensible. Some may ask, which is easier, medical billing or coding? Both are different tasks that combine to ensure an efficient medical billing system or business.

Medical coders are tasked with translating healthcare services into standard codes understandable to insurance companies. These codes prevent any type of confusion or vagueness. Accuracy is critical in the healthcare industry, and insurance companies demand it.

Medical billers file insurance claims based on the documents created by the coders. Billers also post payments when insurance companies complete them.

Most Common Medical Billing Issues

One of the complexities of medical billing and coding is the possibility of claim rejection. Healthcare organizations can always appeal, but the process may take a while.

Healthcare payments are the lifeblood of any medical facility. If payments are rejected or delayed, services may suffer.

The best way to learn medical billing and coding is to also understand the situations that can lead to rejections:

Wrong Codes

It is quite common for codes to be mistyped into the system. People make mistakes. But this issue is also easily corrected when you have the right medical billing software that can flag errors and mistakes.

Overcharging and Undercharging Clients

These could have dire implications for the healthcare facility. Overcharging a client could lead to lawsuits. Undercharging is also bad for business. Either would result in the delay or denial of claims.

Lack of Transparency

Every transaction on the billing system must be transparent. They should be traced to the medical procedure or treatment, and there must be corresponding proof. If there are claims for procedures that were not delivered or other such discrepancies, it constitutes fraud.

Is There a Way to Simplify the Billing Process?

Here are the steps in medical billing:

1. Register the patient

2. Verify the patient’s insurance

3. Translate healthcare services into codes

4. Add charges to medical claims

5. File medical claims to insurers

6. Wait for claims reimbursem*nt

7. Appeal rejections

Every step of the process needs to be accurate and complete.

Medical billing software like BillPRO can help streamline the process. More importantly, errors are eliminated or reduced to a minimum. It has a web-based portal where authorized personnel can access medical billing information. Mistakes are easily spotted and corrected. And when claims are submitted, healthcare organizations can track their status.

Conclusion

Yes, medical billing and coding are complicated. Healthcare organizations must have educated, skilled, and trained personnel to handle the complex process.

However, knowledge and skills are not always enough. Medical billing software can ease the process and prevent errors that could delay reimbursem*nts.