4 Common Problems with In-house Nursing Home Billing

While nursing homes are unique from other healthcare facilities, they face many of the same problems when it comes to medical billing. Over coding, under coding, and the disparity between diagnosis and procedures all play a role in claim denials. Here are just some of the common reasons your in-house billing department may be failing you.

1.    Incorrect Coding

One of the most common pain points for medical and administrative staff is coding. With ICD-9 and ICD-10 coding, there are many opportunities to make a mistake. While incorrect coding can be fixed with the right procedures and knowledge, it is still a costly mistake that rarely gets fixed. It’s estimated that around 60% of returned claims are never resubmitted, resulting in lost revenue and angry customers. Furthermore, many practices have trouble responding to returned claims due to a variety of reasons.

2.    Managing Denials

It is estimated that around 86% of potential claim denials are avoidable. Many practices are not equipped to follow up on denials due to a lack of manpower or knowledge. Most nursing homes are swamped with claims and must work tirelessly to manage submittals and denials. Again, many nursing homes are not able to follow up when denials happen or re-submit claims.

3.    Staffing Issues

Turnover is bound to happen in any profession. People leave for other jobs for other reasons. However, when it comes to medical billing for nursing homes, turnover can produce some serious repercussions. Staffing issues can result in delayed claim submittals and a disrupted revenue cycle. Not to mention, when you hire someone new you have to invest in the time, training, and implementation of that new worker. This is significantly more expensive than having a steady workflow of processed claims.

4.    Lack of Oversight

One of the more complicated parts of medical billing is that it is often susceptible to crime or fraud because of its complex nature. Without oversight, fraud may occur in your medical billing department. Therefore, it is so important to have a resolute leader to oversee your billing or have a third party conduct a review of your services.

6 Reasons to Outsource Your Nursing Home Billing

1.    Correct and Dependable Billing

Incorrect coding can be a worry of the past with an outsourced billing company. You’ll be partnered with a billing agent (or team depending on practice size) that specializes in nursing home billing. They will help ensure that your claims have the right coding to be accepted. Billing agents have an in-depth knowledge of coding and procedures. They’ll know the best method of coding for your patients and your practice and produce faster claim processing time.

2.    Eliminate Claim Denials

Outsourced billing experts are often the first ones to know about changes in policy because they work with insurance companies every day. They have optimized the billing process and can negate mistakes before they happen. Nursing home billing companies can also help you resubmit claims quicker.

3.    Improve Revenue Cycle Management

With a better claims submittal process and fewer denials, you can improve your revenue cycle management. You will work hand in hand with a billing expert that can walk you through the entire process of billing. They will help you optimize your procedures and front office staff to increase your revenue success. You do not have to navigate the complex billing world on your own. Instead, work with a seasoned professional at your side.

4.    Focus Your Resources on Improving Your Practice

Instead of hiring the staff and infrastructure for a multi-person billing department, outsourcing allows you to focus your time and resources elsewhere. You can focus on other important healthcare issues such as machinery, equipment, staffing, or customer enhancements. Outsourcing allows you to improve your bottom line and reinvest that money back into your practice.

5.    Temporary Billing is Available

Have you recently lost a high-ranking staff member for your billing? Is it hard to hire and train billing staff because of the workload, meaning you never truly catch up? Don’t worry, nursing home billing companies can help you also on a temporary basis. Some companies call this “911 billing” or “Emergency billing.” Whichever name, nursing home billing companies can be a stopgap for your company to hire new staff and train them properly. You don’t have to sign a long-term contract and you can remove the service as you see fit.

6.    Improve Compliance

Are you looking to improve your compliance process? Maybe you want to conduct an audit of your billing processes? Nursing home billing companies can help you with this as well! They can help you improve your compliance procedures and make sure they are up to date. Outsourced billing companies can also help you conduct audits of your billing process to make improvements or adjustments. This type of service can be great for those who are looking to keep everything in-house but want to improve their services.