5 Common Challenges in Medical Billing and How to Overcome Them

1. The 5 Biggest Obstacles in Medical Billing and What You Can Do About Them Medical billing is the financial backbone of any healthcare practice. Getting claims submitted correctly and processed on time is essential for healthy cash flow and minimal revenue loss. Yet, new pressures—from evolving regulations to rising patient responsibility—are amplifying old problems and creating new ones. The right tools (like VerdureRCM) can make all the difference. Introduction: Why Billing Is Getting Even Harder What used to be a complex-but-manageable process has become significantly more demanding. Practices now must deal with: stricter payer rules; more patient‐financial responsibility; system fragmentation; and staffing shortages. Each misstep—from wrong codes to missing authorizations—can increase denials, delay payments, and distract from patient care. With a modern RCM platform, you not only respond to these challenges—you anticipate and prevent them. The Top 5 Medical Billing Challenges & Smart Solutions Here are five of the biggest billing challenges healthcare practices face today, along with practical ways to overcome them. 1. Rising Claim Denial Rates What’s happening now: ● Denial rates have increased significantly, driven by new payer requirements such as prior authorization, strict documentation rules, and more exacting coding standards. ● Coordination of benefits issues, unverified eligibility, non‑coverage, and demographic mismatches are frequent denial triggers. ● Surveys show many denials never get appealed or reworked, leading to permanent revenue loss. How to overcome:

2. ● Use real‑time insurance eligibility verification before appointments. ● Deploy AI‑assisted claim scrubbers to catch coding, documentation, or data mismatches before submission. ● Monitor denial trends via analytics; identify recurring causes and feedback loops to correct them. 2. Staffing Shortages, Burnout & Skill Gaps What’s happening: ● Practices are struggling to recruit and retain skilled billing/coding professionals. Burnout is high due to repetitive tasks, long hours, and constantly changing rules. ● Many staff lack training in newer coding systems or adapting to evolving payer policies or tools. How to overcome: ● Lean into automation / AI to take over repetitive, lower‑value tasks (eligibility checks, status follow‑ups, payment posting). ● Offer flexible work arrangements, remote/hybrid work, and better support to reduce turnover and improve morale. ● Invest in continuous education, certification programs, and internal audits so your team stays current. 3. System Fragmentation & Manual Processes What’s happening: ● Many healthcare practices still use disjointed systems (EHR, billing, patient portals) that don’t communicate well. Data often needs manual transfer or reconciliation.

3. ● Manual workflows (paper‑based or spreadsheet‑based) increase error rates, slow down processing, and limit scalability. How to overcome: ● Adopt RCM platforms that integrate with EHRs and payer systems (APIs, built‑in connectivity). ● Automate as many billing steps as possible (coding validation, eligibility, remittance matching, patient statements). ● Shift away from paper/manual workflows; digitize documentation, use data‑entry controls, checks. 4. Regulatory Complexity & Changing Payer Rules What’s happening: ● Coding systems (e.g. shifts like from ICD‑10 to ICD‑11 in some regions), modifications to CPT/HCPCS, and new payer policies are changing fast. Non‑compliance risks (denials, audits, penalties) are rising. ● Prior authorization requirements, documentation rigor, eligibility verification rules are strict and vary payer to payer. How to overcome: ● Keep abreast of regulation changes via billing/coding associations, payer updates, or by using platforms that provide automatic rule updates. ● Use prior authorization automation tools that centralize processes and feed requirement changes into workflows. ● Regular audits / compliance reviews to detect gaps before they become costly. 5. Increasing Patient Financial Responsibility & Revenue Leakage

4. What’s happening: ● Patients are being asked to pay more out of pocket (high‑deductible plans, co‑pays, coinsurance). Practices are seeing more patient responsibility, but collection from patients remains difficult. ● Revenue leakage is common via unpaid claims, underpayments, missed charges, or failure to resubmit denials. Some claims never get revisited. How to overcome: ● Make cost estimation and patient responsibility transparent—from scheduling through billing. ● Use automated tools to identify underpayments, missing codes, or unbilled services. ● Maintain strong denial management and AR (accounts receivable) follow‑up processes. How VerdureRCM Fits In: Tackling These Challenges Head-On VerdureRCM is well‑positioned to help practices meet these evolving challenges by: ● AI & Automation: for coding checks/scrubbing, eligibility verification, prior authorization workflows, and real‑time payer rules enforcement. ● Analytics & Reporting: tracking where denials, revenue leakage, or delays are coming from, and providing dashboards for continuous improvements. ● Integrated Workflow: combining registration, eligibility, coding, billing and follow‑ups into a unified platform, reducing manual handoffs and errors. ● Compliance Maintenance: staying current with coding updates, payer policy changes, and regulatory requirements, helping to reduce audit exposure and denials.

5. Conclusion: Move From Reaction to Proactivity The medical billing landscape in 2025 demands more than just doing things right—it demands doing things ahead of errors. By adopting smarter tools like VerdureRCM, healthcare providers can reduce denials, reclaim lost revenue, ease administrative burdens, and free up staff to focus on what matters—patient care. It’s time to shift from firefighting to foresight.