The Top Four Challenges A Modern Healthcare Payment System Must Face

Healthcare providers up and down the country are finding it harder than ever to track and record their patients’ well-being and health, and many medical practices have discovered that these days, the biggest challenge is just receiving payment for services rendered. Today, providers are discovering that their healthcare payment system is facing a number of challenges that result in a billing process that is more drawn out and complex than it really needs to be. Here are the top four challenges that a modern healthcare payment system must face.

1. Collecting Full Copays

Copays really work as a form of down payment. This means that if healthcare providers do not receive the entire amount of the bill up front, it is highly likely that they will struggle to recoup the remaining portion that the patient owes. Luckily, there are several ways in which losses can be avoided. Asking patients for a credit card that will cover copays during the patient check-in process and before his or her scheduled appointment will help to eliminate this problem. And, for amounts that are not covered by the patient’s insurance, a down payment should be requested on top of all deductibles. When arranging appointments over the telephone, this could be achieved by putting in place a virtual credit card terminal that will allow the patient’s information to be directly entered into the system for immediate coverage.

2. Checking Insurance Coverage Electronically

Another problem that healthcare providers are facing is that patients are not always fully aware of what their insurance covers, and this makes it vital to automatically check each individual patient’s eligibility. Failing to do this can result in severe losses of revenue and a lot of hassles with billing later.

3. Approving Medical Procedures Not Covered by The Patient’s Insurance Or Require Preauthorization

Every patient’s insurance plan will be different, and some insurers do not cover certain elements of treatment. This means that when healthcare providers are preparing to carry out an expensive medical procedure, it is important for them to know whether the patient’s medical insurance plan covers the treatment that will be carried out. Unfortunately, these days, many companies are selecting health plans that have greatly reduced coverage for their workers. This means that some patients will be unable to pay for their share of the treatment. A possible alternative is to offer payment plans for any procedure that results in the patient incurring a large charge. This would make the chances of receiving regular payments much more likely. It is also vital for healthcare providers to check with insurers before carrying out an expensive procedure since many insurers are now refusing to reimburse many procedures without preauthorization.

4. Failing to Stay Up to Date on Coding

Healthcare providers must use the appropriate medical billing code for each procedure and service offered, and, of course, there are often changes and updates to these codes. It is very important for providers to stay up to date with any rewrites to these codes and, therefore, a review of changes should be carried out quarterly at a minimum to make sure that revenue is optimized.

When it comes to receiving revenue owed post-care, healthcare providers are facing more difficulties than ever before. However, it is easier to ensure that maximum payments are recouped and losses prevented by putting in place an effective healthcare collections system that will make it easier for patients to pay the amount owed and easier for healthcare practices to overcome the healthcare payment system challenges that they are facing today.