With so many weak lin

The biggest weak link in medical billing is the system itself. Oh, you can make all the arguments you want about how they're doing the best that they can with a system that was doomed to fail from the start but it doesn't change the fact that the medical billing process is a nightmare to begin with.

Let's start with the billers. Because of all the regulations, a ton of knowledge is needed in order to bill a claim correctly. The truth is, there's not really a lot of training for medical billing personnel. Most of it is on the job training. As a result, a lot of mistakes are made. Now, in most businesses, when a mistake is made, it can be corrected quickly and no harm done. But in medical billing, a mistake means a claim that goes out with the wrong or incomplete information. This results in the claim being denied. The claim then has to be corrected and resubmitted in order to be paid. While there are no hard and fast statistics on the number of claims that are billed incorrectly, it is estimated that it is somewhere in the area of about 10%. That means, theoretically speaking, each day the workload increases by 10% because of claims that have to be resubmitted. This explains why there is such a backlog on claims that need to be paid. It's a never-ending cycle, right out of the gate, that's never going to get any better.

Then there is the inefficiency of the people on the receiving end of these claims. Because the largest claim processors in the United States are from government agencies, these people are not really given the most incentive to do a fast job. So the claim processing process itself, by design, is very slow. This only compounds the problem. But the worst part of it is, the claims that have to be resubmitted are given the lowest priority. This makes it even more critical that claims be submitted properly the first time through.

Finally, as if the above two major problems weren't enough, you have the problem of poorly designed methods for doing the billing itself. This can range from anything from badly designed software, of which there is plenty, to step by step procedures which are inefficient to say the least. Plus, there is no standardization in the industry itself. Once upon a time, there was only one way to bill a claim. Now you have the standard HCFA 1500 form, NSF 3.01 for electronic billing and UB-92 and other formats as well for the electronic transmission of claims. No two medical billing companies do things the same way.

With so many weak link

Let's start with the billers. Because of all the regulations, a ton of knowledge is needed in order to bill a claim correctly. The truth is, there's not really a lot of training for medical billing personnel. Most of it is on the job training. As a result, a lot of mistakes are made. Now, in most businesses, when a mistake is made, it can be corrected quickly and no harm done. But in medical billing, a mistake means a claim that goes out with the wrong or incomplete information. This results in the claim being denied. The claim then has to be corrected and resubmitted in order to be paid. While there are no hard and fast statistics on the number of claims that are billed incorrectly, it is estimated that it is somewhere in the area of about 10%. That means, theoretically speaking, each day the workload increases by 10% because of claims that have to be resubmitted. This explains why there is such a backlog on claims that need to be paid. It's a never-ending cycle, right out of the gate, that's never going to get any better.

Then there is the inefficiency of the people on the receiving end of these claims. Because the largest claim processors in the United States are from government agencies, these people are not really given the most incentive to do a fast job. So the claim processing process itself, by design, is very slow. This only compounds the problem. But the worst part of it is, the claims that have to be resubmitted are given the lowest priority. This makes it even more critical that claims be submitted properly the first time through.

Finally, as if the above two major problems weren't enough, you have the problem of poorly designed methods for doing the billing itself. This can range from anything from badly designed software, of which there is plenty, to step by step procedures which are inefficient to say the least. Plus, there is no standardization in the industry itself. Once upon a time, there was only one way to bill a claim. Now you have the standard HCFA 1500 form, NSF 3.01 for electronic billing and UB-92 and other formats as well for the electronic transmission of claims. No two medical billing companies do things the same way.

With so many weak lin

Then there is the inefficiency of the people on the receiving end of these claims. Because the largest claim processors in the United States are from government agencies, these people are not really given the most incentive to do a fast job. So the claim processing process itself, by design, is very slow. This only compounds the problem. But the worst part of it is, the claims that have to be resubmitted are given the lowest priority. This makes it even more critical that claims be submitted properly the first time through.

Finally, as if the above two major problems weren't enough, you have the problem of poorly designed methods for doing the billing itself. This can range from anything from badly designed software, of which there is plenty, to step by step procedures which are inefficient to say the least. Plus, there is no standardization in the industry itself. Once upon a time, there was only one way to bill a claim. Now you have the standard HCFA 1500 form, NSF 3.01 for electronic billing and UB-92 and other formats as well for the electronic transmission of claims. No two medical billing companies do things the same way.

With so many weak lin

Finally, as if the above two major problems weren't enough, you have the problem of poorly designed methods for doing the billing itself. This can range from anything from badly designed software, of which there is plenty, to step by step procedures which are inefficient to say the least. Plus, there is no standardization in the industry itself. Once upon a time, there was only one way to bill a claim. Now you have the standard HCFA 1500 form, NSF 3.01 for electronic billing and UB-92 and other formats as well for the electronic transmission of claims. No two medical billing companies do things the same way.

With so many weak lin

With so many weak links and many others not even mentioned, it's a miracle that this industry survives at all.