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Top 4 challenges in medical billing and coding for Family Medicine practitioners

A family medicine practitioner treats patients of all ages and with all kinds of ailments. While this may seem like a holistic way to practice medicine, this becomes more challenging for medical billing and coding companies that handle the backend claims for the practice.

There are different sub-segments in family medicine practice, including pediatric medicine, geriatric medicine, palliative medicine, sleep medicine, surgical medicine, and even sports medicine. Each practice chooses to deal with one or all of these sub-segments.

Your billers and coders need to know a wide range of knowledge about what you do, including specific diagnostic procedures and procedural codes and how these change with the age of the patient. Family medical practitioners are constantly busy, as they are the first people families reach out to when someone is unwell. As a result, it is not uncommon for such practices to encourage teleconsultations or online consultations too. If this is the case, then the billing and coding processes get even more demanding. The smallest of misses or errors will lead to claims being denied or rejected.

The main challenges in dealing with family medicine medical billing and coding

You may have an in-house billing and coding team or a medical billing and coding company handle this. Either way, here are challenges your team would face while submitting claims on behalf of your practice.

Documentation challenges

Documentation includes a detailed description of all kinds of services offered to the patient from the minute they make an appointment to the time they walk out. Precise documentation will help billers understand the extent of service offered and raise appropriate invoices. Your billing team needs to be proactive in ensuring documentation happens right and regularly. Some medical billing and coding companies go as far as to handle the documentation hassles themselves.

For E.g., while coding for abdominal tenderness the documentation must clearly specify the quadrant of tenderness (left/right) and also clearly indicate if there is a rebound so that we can identify a specific code. Without this info, the coding would be incorrect (in this scenario the ICD-10 will be R10.819, Abdominal tenderness, unspecified site as the documentation is not clear with respect to the laterality and specificity)

Coding challenges

There are two main challenges with coding for a family practice.

  • There are so many services offered, and many times, multiple diagnostic tests and procedures are performed. As a result, your coder needs extensive knowledge of the codes and modifiers that must be used.
  • CPT/ICD codes and modifiers keep changing over time. The coders must constantly upgrade their skills and knowledge and be aware of industry changes.

For E.g., the E/M changes for 2022 exempt determination of the extent of the history and physical examination. Physicians and coders should complete documentation of medically appropriate history and physical examination. The appropriate level of E/M service is based on any one of two criteria, #1 the level of medical decision-making and #2 the total time for E/M services, coders must understand in detail about these criteria and also know which among them to choose and code.

Delayed AR cycle

Most billers and coders don’t consider this serious until it piles up together and leads to larger damage. The Accounts Receivable cycle is the total time taken between offering a healthcare service and actually getting paid for it. In healthcare, the average AR cycle could be anywhere from 30 days to 70 days. Experts say that if the cycle is more than 50 days, then the practice needs to ramp up its RCM processes to tighten the cycle.

Medical billing and coding companies like Quintessence aim to tighten your AR cycle, so you get paid on time for the services you render. We do this by analyzing the existing RCM processes and making the right changes to them. When your AR cycle is extended, you may constantly suffer from a cash crunch, which would prevent you from growing. While this is certainly a problem, it is something a brand like Quintessence can handle effectively.

Handling unpredictable billing volumes

This is a problem that family practices face early on in their existence. Let’s say you are a family medicine practitioner and are just starting up. You choose to hire an internal team to handle billing and coding. Your practice could see more patients one day and no patients at all the other day. What happens to the billing and coding team when there is no work at all? Paying them every day without clients could be an additional burden on their heads. Similarly, how can a small team manage on days there are excessive bills to be processed?

This problem could be managed easier when you work with third-party medical billing and coding companies that handle multiple clients and have the resources to handle such unpredictability. Quintessence works on a contingency-based fee model with more than 70% of our clients. As a result, they only pay us for successful work, which is easier on them financially.

Why do you need to work with medical billing and coding companies?

You could be a budding startup practice or a reputed family medicine practitioner. Both ways, hiring the right medical billing and coding companies to handle your bills and reimbursements is essential. Here is why.

  • Family medicine practitioners are extremely busy throughout the day and may not have the time to handle the bills and claims themselves.
  • Since diagnostic tests and treatments in a family medicine practice are varied and extensive, you need expert help to keep the initial documentation ready and bill and code in a precise way.
  • Since many bills are generated daily in a family medicine practice, it makes sense to let people who know the trade take over the tasks.
  • Consistent claim denials will prevent your firm from making the revenues it ought to. Over time, this can prevent the practice from growing or sustaining.

Conclusion

As a medical billing and coding company, Quintessence knows how important timely and precise billing and coding are for a family medicine practice. Many such practices stay busy all through the year and have a closer commitment and connection to their clients, which may lead to them not concentrating too much on billing and reimbursements.

Let us take over these complex tasks from you. Quintessence’s expert team of billers and coders knows what works for a practice like yours. Our technologically-backed solutions automate most RCM processes and use AI-based solutions to bring in successful results. We are not mere billers and coders. We become partners with all our clients, creating holistic and long-lasting changes that help them grow and sustain as a successful healthcare brand.

Contact us to know how best Quintessence can help your brand grow.

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