Top 5 Challenges in Immunology Billing and Ways to Navigate Them

Your immunology center’s financial stability is always crucial for ensuring seamless clinical care and operations. Immunology billing takes care of this aspect as it ensures timely and maximized reimbursements of the provided immunology tests and diagnoses. Thus, a perfect immunology billing practice ensures a healthy revenue cycle and improves cash flow so you can invest more money in patient care, resources, and infrastructure.

Unfortunately, most immunology practices often find it difficult to handle complex rules, coding systems, and various compliance regulations associated with immunology billing. At the same time, the landscape of immunology practice regulations is constantly changing. This further adds to the billing challenges. Leaving these challenges unaddressed can lead to claim denials, an increasing number of accounts receivable and poor cash flow for your practice. To ensure a perfect immunology center billing practice, you need to be familiar with the common challenges of immunology billing and their solutions as mentioned below-

5 Common challenges in immunology billing-

1) Documentation and coding errors:

Immunology practice documentation and coding are inherently error prone. Immunology practices often encounter payment delays due to human errors in documentation and coding. In case of inaccurate or incomplete coding, your documentation may lack detailed information about a patient’s symptoms, immunology examination findings and treatment plans. You can avoid such pitfalls by providing adequate training to your immunology billing and coding staff members and concerned physicians. Also, make sure that every coded bill goes through several quality checks before submitting them to the payers.

2) Lack of prior authorization:

Immunology practices often face claims rejection due to lack of prior authorizations. Several diagnoses and treatments in your immunology practice require prior authorization from a patient’s insurance company. It is always advisable to enquire with the insurer about the latest prior authorization guidelines related to the specific treatments that you are going to provide and have the prior authorization.

3) Changing regulations:

The nature of immunology billing is ever evolving with frequently changing regulations. Without an experienced and expert billing team, most mid and small-sized immunology practices struggle to stay on top of the latest coding updates, payer policies and other critical regulations. You should ensure timely training on the latest guidelines for your team. Also, provide your team with latest newsletters and information on various guidelines.

4) Poor denial management:

There could be multiple reasons for a claim denial. Unfortunately, amateur administrative staff members often lack adequate knowledge and experience to identify the exact causes of denials, thus keeping them unaddressed and end up facing more denials and hampered cash flow. To avoid denials, you should streamline a perfect denial management plan that includes tracking denials, following up with insurance companies and resubmitting the claims after correcting the issue.

5) Inefficient patient collection process:

Efficient patient collection management is crucial for maintaining a healthy revenue cycle for your immunology practice. With more high-deductible insurance plans, patients often become liable for paying a large portion of their medical bills and many of them fail to pay their bills on time. You should create transparent billing policies to let your patients know about your payment expectations upfront. Also, provide your patients with multiple payment options to receive timely payments.

Many immunology practices today opt to outsource their billing to third-party revenue cycle management companies to avoid billing issues and achieve optimal results. If you're seeking a reliable billing partner for your immunology practice, consider Sunknowledge. With over a decade of experience, Sunknowledge has successfully supported numerous immunology centers with advanced billing and coding strategies. For a strategic approach to your immunology billing needs, reach out to Sunknowledge's experts today.