The Challenges of Medical Billing in Massachusetts

Photo by Austin-Distel-medical billing massachusets
Photo by Austin-Distel-medical billing massachusets

Commonly abbreviated as MA, Massachusetts is a constituent state of the United States. It is home to Harvard University and Massachusetts Institute of Technology, two of the leading research universities in the world. 

As a result, the state’s economy is highly reliant on technological research and development. In particular, its medical industry is continuously innovating with inventions in progress. 

With Massachusetts’ medical industry in constant motion, there is an observed increase in healthcare expenditures. However, the challenges posed by medical billing in Massachusetts affect the revenues of healthcare providers. Medical billing is a tedious process and can lead to a series of problems if providers continuously get denied claims. 


Patient Information

The first step in Medical Billing Massachusetts is collecting patient information the moment the patient enters the organization. Getting the right information will allow you to process the claims effectively. You also have to ensure that you get information about the patient’s health insurance coverage and status to avoid running into eligibility issues when you submit claims.

Asking the right questions from the get-go will help prevent the occurrence of rejected claims. With patient information being the first step, it is crucial that from the start, billers already get the right information. Otherwise, the errors may translate to the code and the bill.  


Patient Knowledge

Medical billers often struggle to communicate information about bills to patients. Lack of patient knowledge may thus result in payment delays. With technologies like billing software and electronic health record (EHR), this challenge can address this challenge. Such types of software are typically provided by medical billing companies that specialize in medical billing and have access to the latest technologies.

Another difficulty of medical billing Massachusetts is the complexity of patient bills. Bills tend to contain medical jargons that are too technical and specific, and thus difficult to understand. As a result, there is a growing necessity to simplify patient bills and make them much easier to understand. 


Inaccurate Coding

Inaccurate coding proves to be the biggest challenge in medical billing yet, mainly because it results in rejected claims. In 2016, the American Health Information Management Association (AHIMA) identified some of the most common coding errors, which include incorrectly applying the seventh character of trauma or fracture codes. 

It is thus crucial that billers make an effort to review their entries and ensure inputting that codes correctly. Submitting a bill with an incorrect code will be rejected, causing delays and inefficiencies in the entire billing process. 


Manual Processes

Submitting claims involves accurate data collection, practical communication among staff, and streamlining denial management processes. We have to do in unison these steps, and failure to do one can lead to more costs for the provider. The entire medical billing model is much more complicated than it seems, which is why there is much potential for automation. 

Medical Billing Massachusets

By automating the whole claims management process, you can better identify the causes of rejection then work towards fixing the problem. The automation will also help lessen delays, allow billers to file claims in a more timely manner, and help monitor key performance indicators. 

A statistic notes that four out of five US medical bills contain minor mistakes, which costs the nation $68 billion annually in healthcare. Medical billing errors have become almost the norm due to the many challenges involved in the process. 

However, we can mitigate such challenges and prevented them if adequately addressed. Likewise, this problem is also the reason why there are more and more medical billing companies emerging to provide expertise to healthcare providers.    




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