With the increasingly complex world of medical insurance claims, Medicare/Medicaid reimbursements, and other financial concerns, managing the billing process is a challenge for many practices.
Time is Money
According to a Health Affairs study, physicians use nearly 12 percent of their net patient service revenue to cover the costs of “excessive administrative complexity.”
Seventy-four percent of those costs can be attributed to inefficiencies in billing. This is mainly caused by time lost from physicians or staff preparing paperwork or contacting payers directly with questions about prescriptions, diagnoses, treatment plans, and/or referrals.
Finding a Solution
These numbers aren’t surprising to most physicians, many of whom are actively seeking technology-enabled medical billing solutions. Physicians are also increasingly looking for software that manages the entire patient encounter, from pre-registration to payment.
We pulled data from our medical Product Selection Tool — a system that helps narrow down software options for providers — to get a better look at current buying habits. For billing and practice management software, the top two physician-requested features are:
- Integrated EHR
- Patient Scheduling
These requests reflect the need for integrated systems and the importance of patient engagement in today’s healthcare industry.
Based on our interviews with providers, many are replacing outdated or ineffective systems. Furthermore, many want to avoid the hassle and expense of integrating systems from separate vendors — an experience with which most have first-hand knowledge.
Connecting Systems, Patients and Providers
Perhaps the most effective strategy for streamlining medical billing operations is the use of pre-integrated software suites. In a system that combines practice management, EHR, and billing, information flows freely between applications. Therefore, no duplicative data entry or expensive custom software development is required.
According to a recent TechnologyAdvice study, a growing number of patients are seeking digital services from their physicians, especially the ability to request appointments or prescription refills and pay their bills online. There are benefits for practices too — encouraging this online connection can help streamline the medical billing process even further. The best systems allow patients to complete their registration before they arrive at your office. Then their health history and other information flow directly from the patient portal into their electronic health record and your billing system.
Some physicians have given up on complex billing processes almost altogether, electing instead to find a third-party to handle everything. There are a wide variety of options for third-party medical billing and/or coding. Frequently, the best option is your software vendor. They’ll be familiar with the billing functions of your program and often cost less than employing a full-time billing/coding specialist in your office.
Best Practices for Modern Medical Billing
Regardless of which path you choose — in-house or outsourced medical billing — here are three tips for boosting billing efficiency and reducing your days in Accounts Receivable:
Trust, but verify:
Make sure you have a well-established process for patient insurance verification. Some offices make one person responsible for all insurance verifications for that day’s appointments. Having a single process “owner” can prevent miscommunications and reduce the number of dropped balls. Using an online appointment-scheduling interface can also help. You cut down on surprises when your patients provide their insurance information before they even step foot in your office.
Cash is king:
Payment is due when services are rendered. Post a placard with a statement to this effect in the waiting area so there are no surprises. Using an online appointment scheduler to collect and verify patients’ insurance coverage ahead of time will allow you to collect their co-pay or percentage of the bill at check-in. For those patients without insurance (or the increasing numbers of those on high-deductible health plans), consider offering a discounted cash price to encourage full payment and reduce time-to-revenue.
If at first you don’t succeed:
Though claim denials have dropped precipitously over the last few years — an average of just under two percent of claims were denied in 2013, according to the AMA National Health Insurer Report Card — with ICD-10 looming on the horizon, many industry stakeholders expect that number to surge once again. CMS’ latest ICD-10 test saw an 88 percent acceptance rate. If the market sees similar acceptance rates following ICD-10, it would represent a more than 600 percent increase in denied claims. Prepare now by establishing a claim checklist to follow when resubmitting or correcting rejected claims.
Helping You Get There
As always, look to those who have gone before; your peers likely have had or are having the same headaches as your own practice. Seek the advice of those you trust, look at third party reviews when choosing a program, and investigate the support that vendors like CareCloud provide for technical issues.
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