Monday, September 26

Most Common Nephrology Medical Billing Challenges and Their Solutions

Nephrologists are physicians who specialize in kidney-related disorders. Kidney problems are on the rise globally, with billions of individuals needing treatment for renal damage or chronic kidney disease every year. Nephrologists treat a variety of kidney conditions, including renal failure, renal dysfunction, diabetic nephropathy, and kidney stones. Depending on their health, some individuals may or may not require surgery. Therefore, nephrologists have to deal with a variety of nephrology medical billing complexities.

Healthcare practitioners and medical coders could have a hard time keeping up with the ever-changing criteria for medical coding and billing in the field of nephrology.

Due to the importance of proper and timely billing, your medical billing staff must be well-versed in a wide range of documents and codes. Therefore, you may rely on the largest medical billing company in the United States for excellent nephrology medical billing administration. These medical billing companies not only help your nephrology clinic with billing and regulations but also improve your practice’s cash flow.

Handling Different Financial Problems

In most nephrology practices, costs are established by the Medicare Fee Schedule, which means you cannot differentiate your practice by offering good prices. In addition, the majority of professionals deliver excellent treatment. Therefore, how can nephrology practices distinguish themselves from rivals?   Focusing on the patient experience is not just important for differentiating your clinic; commercial insurers, Medicaid, and Medicare are all placing a greater focus on patient satisfaction scores. If these scores decline, there may also be financial repercussions.

Patient Compliance 

Patient compliance is a major concern in the area of nephrology, specifically in dialysis patients. It is quite frequent for prescriptions to not be filled. Patients may attempt to extend the duration of their medicines to reduce out-of-pocket expenses. According to surveys, at least 50% of hemodialysis patients fail to follow a prescribed course of treatment. In addition to putting patients at risk for severe problems, this also impacts healthcare providers.

High rates of claim denials

A common obstacle for nephrology clinics is a high proportion of denied claims. The denial rate is the percentage of claims that are rejected by insurance companies. According to Med Converge, around 26% of all claims submitted to CMS are rejected. Forty percent of these rejections are never resubmitted. Failure to regulate and manage claims denials leads to revenue loss and put an adverse effect on your practice’s bottom line.

As a nephrology practitioner, you most likely face the following key challenges:

  • Scheduling dialysis treatments while traveling
  • Claim rejections and denials
  • Notification of changes in the patient’s condition
  • Maintaining the required documentation
  • Accurately reporting and paying for services

One of the greatest methods to avoid or prevent denials is to understand the tactics for preventing them.

It is important to keep in mind a few nephrology-specific rules to avoid pointless rejections.

  • Always keep in mind that there is no longer a difference between mild, malignant, controlled, and uncontrolled high blood pressure.
  • It’s crucial to remember to code for the stage of the disease while coding for chronic renal disease.
  • It is necessary to highlight the patient’s acute renal failure.
  • The term “acute pyelonephritis” has been replaced by “acute tubulointerstitial nephritis.”
  • When classifying diabetes, you must specify the kind, such as whether it is caused by drugs or chemicals, Type 1 or Type 2, or whether it is linked to another medical condition.

The following are some advantages of nephrology-specific billing that you receive when you work with the largest medical billing company in the USA.

Putting in claims electronically

Manually submitting claims for people who get dialysis takes a lot of time. A single claim may only be submitted at a time by nephrology practitioners using conventional billing software. Nephrology-specific billing, like that provided by iSalus, is able to understand the needs of nephrologists and provides a variety of claim submission options. Providers may categorize and submit claims using this app based on the kind of visit and the insurance carrier. For example, a nephrologist who sees ten level four patients with UnitedHealthcare insurance can send all ten claims with just one click.

Are you worried about your nephrology billing problems?

A nephrologist who is concerned about the problems and challenges in their practice need not be concerned. Nephrologists have relied on Medcare MSO for decades to handle their revenue cycle and practice management needs. We can assist your nephrology clinic with billing and coding, healthcare IT support, and EHR setup, all of which may improve cash flow and practice administration. We also provide complete nephrology billing services as well as best-practice process management to help you minimize your reimbursement cycle, expand revenue streams, and optimize profits.

As a result, contact us right away to learn more about how we may improve your billing process and boost your practice’s profitability.