The impact of prolonged turnaround times from billers in medical billing is frequently underestimated, yet it has far-reaching consequences for everyone involved. Delays in processing times impose financial burdens on healthcare organizations and patients. By gaining insight into the concealed costs and inefficiencies, we can enhance the process and achieve more favorable financial outcomes.
In our previous discussions, we explored how initial delays in medical billing can arise from factors beyond the biller’s control. However, it is not uncommon for additional delays to occur once an apparently completed claim is handed over to the biller, mainly due to the overwhelming volume of incoming claims that billers must manage.
The average claim submission time in medical billing is typically one to two months. However, to provide a real-life example, we collaborated with a practice that uncovered an astonishing average time of 110 days, equivalent to over three and a half months.
Through the utilization of technological advancements, they successfully reduced the biller’s processing time to just one day. While delays are prevalent in medical billing, they come with substantial costs. Let’s delve into the numbers to gain a deeper understanding of the magnitude of this issue.
Emerging studies have shed light on the unexpectedly sluggish turnaround times in medical billing, with averages ranging from one to two months. These findings emphasize the significant time commitment required by billers and the overwhelming volume of claims they handle. However, by harnessing the power of technological advancements in the field of medical billing, we can unlock the potential for substantial time and cost savings.
Why is Speed a Critical Factor?
In addition to the disruption it causes to cash flow, leading to challenges in meeting financial obligations such as staff salaries, leases, or purchasing supplies, the impact of delays in billing and reimbursement extends further. Healthcare providers are estimated to lose up to 30 percent of their potential revenue as a result of these delays. This staggering figure illustrates the significant implications for the overall healthcare system, with hundreds of billions of dollars being lost annually. To provide some context, imagine a bustling hospital that welcomes hundreds of patients every day, each requiring a range of medical services, including tests and surgeries. For the hospital or practice to operate smoothly, it is crucial that all these services are billed and reimbursed accurately and promptly. Unfortunately, when medical billers experience delays in their turnaround time, a substantial portion of revenue remains uncertain. This situation highlights the critical importance of addressing and improving the efficiency of billing and reimbursement processes to prevent significant revenue losses.
As time progresses, two potential scenarios can unfold. Firstly, the provider who rendered the service may no longer be affiliated with the practice or hospital, rendering them unavailable to address any inquiries. Consequently, the associated payment may go uncollected, resulting in a loss for the healthcare provider.
Secondly, delayed claim submissions can collide with insurance submission deadlines. The longer the delay, the greater the likelihood of encountering higher rates of rejection or denial. This can be attributed to rushed submissions that are prone to errors or the realization of missing information during the process. Such circumstances further exacerbate the financial implications for healthcare providers.
Missed Submission Deadlines Lead to Revenue Loss.
Now, let’s delve into the potential solutions for this issue. Fortunately, the healthcare industry is actively addressing these challenges. With the advancements in technology and the emergence of artificial intelligence (AI), healthcare providers are exploring billing systems that utilize machine learning algorithms. These algorithms automate the claim submission process and monitor its progress, enabling billers to handle a larger volume of claims more efficiently. Consequently, the likelihood of delays decreases while revenue increases.
Furthermore, the integration of electronic health record (EHR) systems with billing software is gaining traction. This integration allows for real-time documentation and immediate claim submission. By eliminating the need for duplicate data entry and reducing errors, the billing process becomes faster and more streamlined.
By embracing these technological solutions, revenue cycle management becomes significantly more efficient. This enables clinics, hospitals, and practices to focus on their core strengths: delivering excellent healthcare to their patients.