2020 has been a year of crisis in terms of healthcare, economy, and regulatory changes. The world has faced every possible trouble including the most destructive COVID-19 pandemic situation which has influenced the global economy. But it seems that the situation might worsen in the upcoming time and 2021 can be more challenging for businesses. Talking about the healthcare sector 2021 will certainly bring challenges for practitioners and physicians around the globe in terms of medical billing. With the changing social, healthcare, and coding regulations the upcoming time will bring unseen challenges. Also, the documentation guidelines for evaluation and management (E/M) services will change as proposed by the Centers for Medicare & Medicaid Services (CMS) in 2021. So, it is necessary for physicians to analyze and prepare themselves for major billing-related challenges. Here’s a list of the top 5 challenges for physician billing services in 2021:
1. Current Procedural Terminology (CPT) changes: The American Medical Association (AMA) has prepared a list of new CPT code descriptors for medical diagnosis and procedures as well as other outpatient services (new and established patients). These changes will be based upon the level of medical decision-making (MDM) or the time spent by the provider on the encounter. The new code will specify a medically appropriate history and/or physical examination and a specified level of MDM.
2. Increased claim denials: The regulatory changes and changing medical conditions among patients will bring an increased burden on physicians. A small error on coding or billing might lead to denial of claims which will damage the financial health of a practice. So, it is important for physicians to prepare for these conditions well in advance.
3. Complicated Revenue Collection: Understanding the new coverage policy of insurance payers will require some time. This might lead to confusion or denials of certain claims and will complicate the revenue collection process for physicians. Non-coverage of certain services and high deductible plans might also delay payment for practitioners.
4. Outdated EHR interfaces: The new CMS documentation guidelines will bring changes in electronic record keeping. All the existing EHR interfaces will become outdated. Physicians will have to use efficient and effective software solutions for record keeping and billing otherwise it will negatively impact billing services.
5. Excessive Administrative Burden: Physicians have been managing the dual task of patient care and medical billing services. But, the COVID-19 situation has made the scene more complicated. Physicians are finding it difficult to train their employees for these changes. This increased administrative responsibility might negatively impact the revenue cycle for a physician’s practice.
The upcoming challenges in physician billing practices might negatively affect the cash flow of practice. So, it is necessary to prepare beforehand for all these challenges and adopt a strategy that could benefit your practice. Outsourcing professional billing services is one of the best ways to deal with all these challenges. Professional billing service providers will take care of all billing-related issues and will boost revenue.