5 major Medical billing challenges that no one is talking about

5 major Medical billing challenges that no one is talking about

Shivam Shekhawat


Medical billing has always presented its own set of problems. This effort to secure appropriate reimbursement has become more apparent than ever because of the altered billing environment following the pandemic. Triyock observed these issues as a top medical billing service provider and covered the top 5 in this post.

        A. Explanation of medical billing

Medical billing is the process of preparing medical claims to send to insurers in order to receive payment for healthcare services rendered by providers and provider organizations. The medical biller converts a healthcare service into a billing claim and oversees the claim to ensure that the organization is paid for the provider's work. A skilled medical biller can boost the revenue a doctor's office or healthcare facility generates.

        B. Overview of the challenges faced in medical billing

Billing issues including lost revenue, delayed payments, and mismatched medical coding systems are causing major issues for medical institutions throughout. Solutions such as widening payment accessibility, staying up to date with patient information, and educating people more about medical billing are needed to reduce the amount of money lost to billing errors. Smart billing solutions are essential for the seamless sharing and understanding of information, eliminating errors, dealing with complaints, and keeping track of cash flow and revenue payments. However, they often need to include more support in implementation, leading to further problems. Establishments and their teams need sufficient training and tech support to take over the role.

        C. Introduction to BPO (Business Process Outsourcing) and how it can help.

Medical billing is essential to hospitals' and healthcare service providers' revenue management strategies. Millions of dollars are lost each year due to undercharging, coding mistakes, missed charges, and unpaid claims. Outsourcing medical billing services to BPO allows these losses to be avoided and the medical billing can be handled correctly. BPOs like Triyock constantly assist clients by relieving them of the tiresome responsibilities of billing and follow-up by using our professional approach and knowledge. The medical billing solution from Triyock uses the most recent software and technology advancements and is very user-friendly. Our medical billing service is tailored to each client's unique needs.

Major Medical Billing Challenges

        A. Challenge #1: Staffing issues

1. Staff turnover

Medical billing and coding personnel must always be available, according to healthcare practice administrators. A revenue cycle management partnership that offers proactive advice, data insights, and training to enhance key performance indicators may be beneficial for practices that lack the resources to keep on top of medical billing and coding issues (KPIs).

2. Inadequate training

You will want a skilled medical billing staff due to the numerous modifications in billing and coding for your field of medicine. You cannot expect your front desk staff to manage medical billing for your business effectively. You cannot afford to lose even one claim to rejection or denial given the altered billing environment. The financial viability of your practice is guaranteed by hiring knowledgeable billing and coding specialists who are familiar with billing for your medical specialization.

        B. Challenge #2: Constantly changing regulations and policies

Medical billing and coding standards are constantly under change every year, leaving some healthcare practices more susceptible to compliance concerns and disrupted revenue cycles.

The shifting healthcare landscape presents a number of difficulties, changing billing guidelines being only one of them. People are now exploring new jobs both inside and outside of their disciplines as a result of the changing nature of the labor force. Medical practices have also been impacted by this phenomenon, to the point where many institutions are experiencing a personnel shortfall that is affecting more than just front-line healthcare workers. The movement has also attracted administrative workers, of whom medical billing and coding specialists are essential members.

        C. Challenge #3: Claim denials and delays

There will be more claims that are denied and rejected when there is such financial uncertainty. Every payer often adjusts its billing policies and reimbursement guidelines due to the dynamic nature of the healthcare industry. It is evident that you will experience more claim denials if you do not stay updated with developments. Payers are also modifying their prior authorization requirements. It is challenging to reverse the payer's decision only to accept a claim if you obtain such prior authorizations. The growing number of denied claims is also having an adverse financial impact on practices. Every year, any practice typically receives 5 to 10 percent of claim denials. Rejected claim numbers are likely to increase as more people lose their employment and the employer-sponsored insurance that comes with them.

        D. Challenge #4: Technology and software issues

The medical billing sector has undergone a transformation, becoming more accurate and efficient thanks to the use of technology and software. Yet, there are still issues that must be resolved. The integration of various software systems used by healthcare providers, insurance providers, and billing firms is among the major problems. Data transmission issues and processing delays for payments may result from this.

        E. Challenge #5: Patient data privacy and security

Keeping patient information secure and private is another difficulty. There is a risk of data breaches and cyber attacks when electronic health records (EHRs) and online billing systems are used more often. To protect sensitive patient information, medical billing businesses must have strong security measures in place.

How BPO can help overcome these challenges

For tasks involving billing, a doctor or nurse is not required to have such training. A non-medical professional who has some familiarity with the organization's fundamental operations as well as with accounting and software programs can handle it. Outsourcing Medical Billing to BPO frees up medical professionals to focus on their core duties, which is what we need them for, by hiring such professionals and outsourcing tasks to them that only require taking up a finite number of medical professionals. We allow them to concentrate on the patient, who serves as their purpose.

How Medical Billing is Helped by BPO?

        A. Dedicated and trained staff

Healthcare practitioners are assisted by experts from Medical Billing BPO in adhering to the numerous regulations of a governed civil society. They even keep track of patient information and records. If Medical Billing is outsourced, experts in the relevant fields can conduct it more effectively. Whenever a client requires it, BPOs offer access to specialists around the clock.

        B. Expertise in regulations and policies

As mentioned above help healthcare practitioners stay in compliance with government policies and are prepared to offer help around the clock from all of their global delivery locations.

        C. Advanced claim processing and management

Medical billing manages the revenue cycle for medical service providers, which is a crucial component of any commercial operation. The fact that payment is frequently paid by a party other than the party receiving the service—i.e., the insurer, with whom the service user has a separate arrangement—adds to the complexity of healthcare. By handling this function with the attention it requires through medical business process outsourcing, money can be freed up to operate the client's services.

        D. Up-to-date technology and software

BPO services can offer real-time data analysis and reporting using the most recent software, which enables healthcare providers to make knowledgeable decisions about their revenue cycle management. Medical providers who outsource their medical billing to BPO firms can take use of the most recent hardware and software on the market. These innovations aim to speed up billing procedures, cut down on mistakes, and boost precision.

BPO firms spend a lot of money and time training their employees on how to use these latest technologies efficiently. This guarantees that they can offer clients high-quality services while abiding by rules and regulations in the business. Healthcare providers can concentrate on providing high-quality patient care by outsourcing medical billing to BPO services and leaving the administrative work to professionals.

        E. Compliance with patient data privacy and security regulations

Patient data security and privacy have grown to be a top priority for healthcare professionals in the current digital era. For the safety of patient information, the Health Insurance Portability and Accountability Act (HIPAA) has established tight rules, and any infringement can result in substantial fines and legal action.

You may ensure that you comply with these rules by outsourcing medical billing to a reputable BPO service provider. These businesses have qualified staff that is knowledgeable about HIPAA rules and can handle private patient information with the highest care.

Benefits of outsourcing medical billing to a BPO

Healthcare providers can concentrate on offering their patients high-quality care while maintaining the security and safety of their patient data by outsourcing medical billing to a BPO service provider. In addition to saving time and resources that might otherwise be used to manage compliance issues, this promotes patient trust.

        A. Increased revenue

A Healthcare BPO is made to increase your practice's financial effectiveness and revenue. Instead of hiring specialists in medical billing and coding for your clinic, you can have access to their knowledge by outsourcing these jobs to experts. By outsourcing, you can lower your operating expenses while refocusing your efforts on your core business operations. You can invest money in a better way that would otherwise be used for salaries and other expenses.

        B. Improved accuracy and efficiency

You have access to a large, skilled workforce when you outsource your healthcare BPO services, which helps you improve productivity and save expenses. A good practice will have quick, accurate, and open billing procedures.

        C. Reduced costs

BPO services relieve healthcare providers of the need to invest in expensive hardware and software. The BPO service provider frees up valuable resources for the healthcare industry by taking care of all technological requirements, including upgrades and maintenance. Medical billing outsourcing through BPO services can significantly reduce operating costs for healthcare providers. By working with a reliable BPO service provider, healthcare organizations may speed up their billing processes and ensure rapid and accurate claim filing. Faster reimbursements and improved cash flow follow from this.

        D. Improved patient satisfaction

Patients will be met by a representative from the medical BPO company when they contact agents to talk about their medical bills. Your internal staff will have less work to do because they won't have to answer every customer's inquiry. Without being under pressure to manage a hospital at the same time, the agent assigned by the third-party billing service will handle all complaints, respond to inquiries, and provide the help your patients require.

The medical BPO will also minimize any errors by ensuring that each code is submitted accurately and with the appropriate reimbursement. If there are any issues, they may be swiftly fixed, and each rejection is immediately followed up on.

Payers receive their invoices on time, all issues are professionally resolved, and your healthcare staff is free to focus more on the patients. If you have the correct group of people managing your patient-care issues, your patients' experiences will be more favorable, and your customer satisfaction will increase.

        E. Increased focus on core business activities

In a hospital setting, healthcare professionals are typically not at all involved in the business end of the practise. Does that imply that the administration should bear the full burden of the commotion? They are also occupied with overseeing the ER department's clinical and administrative effectiveness, which also relates to patient care.

Your healthcare professionals and other staff members can continue to concentrate on their assigned tasks by outsourcing billing and collections to a medical BPO. This makes room for expansion and opens the door to future increases in compensation. Most importantly, you can fire the administrator so they can concentrate more on attracting new clients and keeping those they already have.


The medical BPO you choose to engage with will have a big impact on how successful your healthcare outsourcing is. There are a few considerations you should make while choosing an outsourcing partner. Verify that the provider is adhering to all information security guidelines.

Spend some time looking into their experience level, history of providing billing services, and feedback from prior customers. Consider the existing state of the medical BPO company's labor market. Last but not least, determine whether their service packages are suitable for your requirements. Choosing the proper provider will ultimately lead to dependable long-term collaboration and an efficient billing procedure.

About Author

Shivam Shekhawat

Shivam Shekhawat is a content writer for Triyock BPO, a leading global management consulting firm that offers end-to-end business process outsourcing solutions. He has in-depth technical knowledge and domain expertise in data management, Web research and image editing.

View more from this Author

Speak to our advisors about your queries and get an end-to-end service quote free

Our Carefully Considered Pricing Structure For our Services

Hourly Rates

Starting from: $4 Per Hour

Contact Us