Medical billing is more important than ever as practices contend with a host of challenges that eat into their bottom line.

In this article, we'll look closely at some common challenges of medical billing and consider how the right practice and revenue cycle management platform can help ease the administrative burden, minimize claims denials, and reduce the time from providing services to getting paid.

If you’d like to read more about the basics of medical billing (and how it differs from medical coding), read our companion article, What is medical billing?

What are common medical billing challenges?

Medical billing is a necessary part of every practice, but it can be difficult to manage. Fortunately, there are both technology and services solutions available that can be leveraged to help.

Here are some of the most pervasive medical billing challenges in US healthcare today, and how providers are solving them.

Challenge #1: Administrative burden

When done manually, medical billing can become an enormous administrative burden. Managing billing errors and denials, and working with payers to address them, can be very complex and time intensive. Unfortunately, this kind of manual work often piles up and becomes overwhelming. For instance, according to recent research, 64% of physicians say they feel overwhelmed by administrative requirements and burdens at least once-per-week.¹

Unfortunately, simply adding headcount isn’t the remedy it might appear to be. Staffing is another common challenge, with 78% of physicians claiming that staff shortages and/or poor retention are current challenges. Across the industry, practices are struggling to hire and retain qualified staff for roles around RCM, like medical billing.²

Solution: Streamlined workflows

The right revenue cycle management platform should be built with both flexibility and automation in mind, which contribute to more streamlined workflows and ease administrative burdens. Providers should be able to customize and optimize their medical billing workflows and automate a variety of accounts receivable tasks.

Using technology that enables providers to adjust workflows to their needs can help streamline the entire medical billing process, from patient registration to claim submission and payment posting.

Challenge #2: Compliance with medical billing guidelines and regulations

Most healthcare organizations work with a variety of payers. Each payer—whether insurance, government, or other—has unique and often evolving requirements for claims. Deep industry knowledge is often required to build an efficient, compliant, and successful medical billing process.

Rules around billing are also likely to grow more complex as alternative payment models like value-based care take root in the US and are embraced by practices to diversify revenue and recalibrate provider/patient priorities.

Solution: Medical coding automation and operational services

While medical coding and medical billing are two distinct functions, they are intertwined. Medical codes are what much of medical billing is built upon, so accuracy is paramount. However, this often-manual process is difficult to scale when practices grow and evolve and medical coders are one of the most challenging roles to hire for and retain in today’s employment market.

Thankfully, automation can help. Some practice management platforms are built to scrape clinical documentation to produce accurate codes for billing. Certain vendors also leverage deep industry expertise to offer specialized services to take over the medical coding function. Often, a combination of innovative technology and managed services for medical coding can help practices scale their medical coding function while achieving better compliance with medical billing guidelines and regulations.

Importantly, this approach can also help ease the burden of staying compliant with regulations like HIPPA and the Affordable Care Act, which have direct impacts on medical billing and have been shown to be another significant burden for physicians.

Challenge #3: Data management and quality control

The information needed to support accurate and complete medical billing can be difficult to find and manage when it comes from a variety of sources. Clinical documentation, typically stored within patients’ electronic health records, is used to determine or generate the medical codes that facilitate billing. Certain patient data, including demographics, insurance details, and billing records, are often needed as well.

Tracking down this data and keeping it clean—especially when data must be exported from various systems—can slow the process greatly, and any quality control failures lead to increased claim denials, ultimately slowing down payment to practices.

Solution: Integration with electronic health records

Some medical billing solutions are integrated within a comprehensive healthcare IT platform alongside capabilities for electronic health records (EHR) and patient engagement tools. This integration allows for seamless sharing of patient information between billing and clinical workflows to increase efficiency, accuracy, and overall quality control. It also has benefits for patients, who likely appreciate the billing access and transparency offered by patient portal payment tools.

Using an integrated and comprehensive platform combining revenue cycle management, electronic health records, and patient engagement functions provides benefits across the revenue cycle and can reduce a variety of data-related burdens.

athenaOne® for medical billing

athenaOne is a comprehensive healthcare IT platform featuring robust capabilities around practice and revenue cycle management, electronic health records, and patient engagement. The platform is built to help healthcare organizations deliver outstanding, patient-centric care while maximizing revenue.

athenaOne features a billing rules engine with more than 30,000 rules (and growing), helping practices streamline their billing process and avoid costly claim errors.³ Users are supported by experienced teams with deep knowledge of payer billing requirements, evolving healthcare regulations, and operational best practices for healthcare providers of all kinds. Additional services are also offered through the platform to help scale processes, like athenaOne medical coding.

With athenaOne’s medical billing capabilities, you can:

• Simplify and streamline medical billing and coding workflows
• Get paid more of what you’re owed, faster
• Optimize financial performance with reporting and analytics
• Increase claims coding accuracy and reduce risk
• Spend more time focused on patient-centered care

Building a successful medical billing process

Medical billing is a crucial element of revenue cycle management. It's important to build a medical billing process that is accurate, scalable, and helps you get paid more of what you're owed, faster.

Contact an athenaOne medical billing expert today to learn how an integrated healthcare platform can help you streamline the medical billing process, improve your claims accuracy, and help your practice stay focused on what matters most: delivering excellent care to patients.

1. AAPC, What is medical coding; https://www.aapc.com/resources/what-is-medical-coding

2. Ibid

3. Based on athenahealth data as of Mar. 2024; M017