The impact of high turnaround times from billers in medical billing is often overlooked, but it affects us all. Delays in processing times create financial strain for healthcare organizations and patients. By understanding the hidden costs and inefficiencies, we can improve the process for better financial outcomes.
Previously, we discussed how initial delays in medical billing can stem from factors beyond the biller’s control. However, when an apparent completed claim is handed over to the biller, it is not uncommon for further delays to occur due to the sheer volume of incoming claims billers must handle.
One to two months are considered the average claim submission time. However, to paint a vivid picturefrom first-hand experience, we worked with a practice that discovered their average time was a staggering 110 days, or just over three and a half months. They managed to bring the biller’s processing-time down to one day by leveraging advancements in technology.
Though delays are common in medical billing, they come with significant costs. Let’s delve into numbers to better grasp the magnitude of the issue.
Recent studies reveal surprisingly slow turnaround averages for medical billers to process a claim – anywhere from one to two months – highlighting both the substantial time investment involved and the mountain of claims passing over their desks.
Leveraging technological advancements in the field of medical billing highlights the potential for substantial time and cost savings.
But why does speed matter?
Aside from cash-flow disruption – which can make it challenging to meet financial obligations, such as paying for staff salaries, leases, or purchasing supplies – it is estimated that delays in billing and reimbursement cause healthcare providers to lose up to 30 percent of their potential revenue. With nearly a third of the revenue at stake, imagine the impact this has on the overall healthcare system. We’re talking hundreds of billions of dollars lost each year.
To put these claim quantities and revenue at stake into perspective, consider a bustling hospital with hundreds of patients coming through its doors every day. Each patient requires various medical services, from tests to surgeries. All of these services need to be billed and reimbursed properly to keep the hospital (or practice) running smoothly. However, with a delayed turnaround time from medical billers, a substantial chunk of revenue is left hanging in the balance.
Two things can happen as time goes by. One is that the provider who performed the service may no longer be with the practice or hospital, for whatever reason, and thus is no longer able to answer questions. Therefore, the money falls off the table.
The other thing that can happen is that delayed claim submissions bump up against a closed insurance submission window. The more delay, the higher the rejection or denial rate, due to errors in rushed submissions or discovery of lack of information.
When the submission window closes, revenue is lost.
Now, let’s talk about solutions. The good news is that the healthcare industry is not turning a blind eye to this issue.
With advancements in technology and the rise of artificial intelligence (AI), healthcare providers are exploring billing systems that leverage machine learning algorithms to automate the submission of claims and track their progress. This helps billers process more claims, faster, decreasing the chances of delays and increasing revenue.
Additionally, electronic health record (EHR) systems are being integrated with billing software, enabling real-time documentation and immediate claim submission. This integration eliminates the need for duplicate data entry and reduces errors, speeding up the billing process.
By adopting these technological solutions, revenue cycle management becomes more efficient, and clinics, hospitals, and practices can focus on what they do best: providing excellent healthcare to their patients.
Programming note: Listen to Susie Vestevich report this story live today during Talk Ten Tuesdays, 10 Eastern, with Chuck Buck and Dr. Erica Remer.
A recent qualitative study published in the Journal of the American Medical Association (JAMA) Network Open explored the implementation of social determinants of health (SDoH)
Today, I want to shine a light on something that is often overlooked but is absolutely critical to the financial health of our healthcare system:
Please log in to your account to comment on this article.
Physician queries are essential for accurate documentation and claims data, but they are increasingly scrutinized by payors, leading to denials and revenue leakage. This webcast, led by industry expert Cheryl Ericson, RN, MS, CCDS, CDIP, provides actionable strategies to craft compliant queries, reduce denials, and enhance revenue integrity. Attendees will gain insights into clinical validation queries, how to avoid common pitfalls, and learn best practices to defend against query denials. Don’t miss this opportunity to refine your query process and protect your organization’s financial health.
Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
