Emerald Health LLC - Electronic Referral System and EMR Software


Medical Billing Insurances – Why Many Medical Centers Are Losing Out on Revenue

Medical billing and coding is an extremely important part of any medical center. It should function as a well-oiled machine ensuring that all the processes flow and are accurate. It is too important a process for any physician or medical center for it to be done incorrectly. When mistakes are made, it can be all too costly. Claim rejections or denials can account for a vast amount of lost revenue, even if only a small percentage fails to go through, over a period of weeks, months or even years, this is considerable.


Medical billing is something that many medical centers or solo physicians dislike. It is, after all, a part of the job that they do not specialize in. But, to keep the center or practice open, it’s an essential element. Outsourcing the role to a company who provides this service is one option and this can ensure a seamless approach to increasing revenue. There are several reasons as to why revenue is lost, and this includes internal billing errors, medical necessity denial – so not appropriate for the medical/reimbursement policy or, it’s a payor error. Either way, the result is a loss of income. It can be difficult for any medical practice to understand and abide by the small print of each medical insurance, coding is often in error and sometimes, patients are simply not covered. This is why hiring in specialists who keep up with legislation is important or, outsourcing makes absolute sense and saves time, headaches and a loss of income. It is why physician billing services are important and must be given priority status.

Reimbursements from insurance claims

Certainly, claim rejections and denials can start to add up and ascertaining where the issues occur means checking for internal billing errors, identifying the number of dollars lost and then, sharing these findings with the staff members who deal with it. Or, where one payor error is the main contributor, it’s wise to contact them directly to ascertain the root cause. Where medical necessity denials are an issue, it’s important to ask for a copy of the medical policy to see whether diagnostic codes were incorrect or whether there is a conflict with that payor’s medical policy. If mistakes are being made in-house, then it is important to discuss with those staff responsible and to use this as a training tool. This is why medical billing specialists have so sought after. They must understand the insurance policies for each patient and go by these guidelines to ensure an accurate claim takes place. This ensures less money is lost through human error.


It makes sense to streamline the whole process and to let the experts take responsibility for the money that has been earned. This way, failed payments will very quickly become a thing of the past. When outsourcing or if using medical billing systems, it can become an immense relief to know that this side of the business is now in safe hands. The specialist can negotiate between the insurers, the coders, and patients and make sure that bills are paid in a timely fashion leaving the medical work to those who are passionate about the patients’ health.

Share your Story. Choose your Platform

Leave a Reply

Your email address will not be published. Required fields are marked *