Administrative demands in the healthcare industry are complicated and if we have learned anything over the years, it is that there is never a one size fits all solution when it comes to the healthcare system. One of the biggest reasons for that is because providers face different challenges than payers do, and the commercial and federal healthcare landscapes are very different. However, when administrative challenges are overwhelming, it can be felt across the entire healthcare ecosystem.
In this first edition of Exploring the Complexity of Healthcare in the U.S., we are taking a closer look at some of the biggest professional and administrative challenges that providers are facing in the United States.
Healthcare Administrative Demands Accelerate Physician Burnout
Essential administrative demands, such as medical coding and billing, is a time consuming task that continues to fuel an existing issue of physician burnout. Physicians are called to the industry because they want to be hands-on to help those who are in need of care, not to be stuck at a desk doing paperwork. With healthcare being an evolving industry, especially when it comes to technology and compliance regulations, providers can quickly begin to experience burnout symptoms due to the ever-changing and increasing burden of healthcare administrative demands. The physical and emotional toll that burnout causes leaves physicians unable to stay connected to the personal calling that got them into the healthcare field in the first place.
When providers become over extended due to the burden of administrative demands and cannot take on new patients, access to quality care decreases, the patient experience suffers, and providers retire much earlier than expected or leave the profession entirely. With an increasing backlog of paperwork and interoperability challenges within electronic health records (EHR) causing communication barriers within care coordination, more errors are possible, and patients receive subpar care from unintentionally distracted providers. All of these components lead to a stressed healthcare experience for everyone involved. As many communities continue to heal from the pandemic, ensuring that high-quality care is available is more important than ever before.
Improper Coding and Billing Impacts Healthcare Costs
When was the last time you really took a close look at a medical bill you received? Chances are you have seen a group of numbers on your bill that were not a part of the payment you were asked to submit in the “You Owe” column. Sometimes all of the different numbers can be confusing, but those International Classification of Diseases (ICD), Current Procedure Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes play an essential role in medical billing. If not documented accurately by providers or their staff, it can have a negative impact on healthcare administrative costs.
Because these ICD codes are how medical practices turn services they provide into billable revenue, it is important for the codes to be used correctly in order to avoid denied and rejected claims that result in delayed payment to a provider. When medical coding or patient information errors are happening, whether knowingly or unknowingly on a grand scale, the stress put on the revenue cycle process can have major consequences for the provider’s bottom line.
Ensuring that codes and patient information are being documented correctly can be a difficult manual task since codes are added, updated, and retired frequently and manual documentation errors are easy to make. The expansion of medical coding happened almost overnight during the onset of the COVID-19 pandemic as new codes were adopted to highlight what kind of treatment or immunization was provided to a patient. The constant evolution of medical codes, compliance regulations, and new processes driven by technology has proven to take a toll on providers over the years.
Lowering Healthcare Administrative Costs is a Calling for Signature
When it comes to healthcare in the U.S., the more you can simplify any process, the better the experience is for providers, payers, and patients. Healthcare administration costs are on the rise to almost making up 40% of all medical bills received. Keeping that number low impacts not just the healthcare organization, but also those who are being billed for the treatment they received. By ensuring that documentation is correct before it is sent to the payer, the flow of the revenue cycle can go uninterrupted and healthcare administration costs can be kept at a minimum.
Healthcare administration is complex and hard to do well, but our team at Signature has tapped into some of the most innovative minds in the industry who are dedicated to solving and streamlining administrative burdens for providers in both the federal and commercial healthcare arenas.
Our team’s mission is improving not only our clients’ business, but the entire healthcare industry by finding better ways to leverage technology, implement operational readiness, and other industry-leading processes which provide technical solutions and ultimately lower the cost of healthcare administration. Every day, our team channels our passion for our mission in a way that allows us to solve some of the most complex challenges facing the healthcare industry. We believe the healthcare industry in the United States deserves only the best, and that sentiment is what motivates our dedicated team to do our very best.
Read the second article in this series: Exploring the Complexity of Healthcare in the U.S. for Payers
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Justine Olsen is the Director of Data Intelligence and Operations at Signature Performance Inc., in Omaha, NE. Signature Performance is an industry leader in reducing healthcare administration costs for private and public healthcare sectors. Our unmatched experience in serving both the payer and provider side of healthcare financial management allows us to implement innovative solutions for every administrative demand.