Medical billing is one of the invisible engines of the healthcare sector. In the absence of medical billing, it would be tough to efficiently transmit critical data which can make it hard for healthcare providers to get paid for their services. The biggest hurdle faced by healthcare organizations is their ability to collect money from their patients. For healthcare centers to be profitable and achieve success in their operations it is critical for them to have an efficient billing and collection system and any efforts made towards improving this system can help the organization better capture money and avoid huge loses.
The evolving nature of healthcare payments industry means that the billing services must also take adequate steps to accommodate those changes. The increasing complexity of medical insurance claims, Medicare reimbursements and various other financial concerns are making billing process quite challenging for healthcare organizations. Efficiency, interoperability, payment best practices and security will be the key areas that the healthcare industry must focus on as the industry continues to rapidly change and grow. Healthcare organizations can perform medical billing in a better way by following few best practices that can make collecting money more efficient and increase insurance claims approval.
Here are best practices in Medical Billing:
According to Centers for Medicare & Medicaid Services (CMS), the US healthcare payments market may reach $5 trillion per year by 2022 and will include both payer and consumer payments. But a Consumers Union report released in 2014 reveals that more than 30% of money is wasted as a result of inefficient payment processing, billing and administrative processes. For healthcare organizations to collect more payments, they must recognize the critical role that consumer choice plays and the digital economy’s impact on new payment channels and address them adequately so that payment expectations can be met.
Apart from leveraging technology, cultural changes must also be fostered among the patients and staff members so that the patients are better prepared to pay and the staff members to collect. Policies and tools which may include prompt pay discounts, minimum payment requirements, staff incentive programs and referring scripts when payments are being discussed with patients are some of the effectives ways of collecting more revenue.
A medical billing audit conducted during the complete operational assessment or for different segments can reveal the true weaknesses and strengths in the process of medical billing. Billing documentation and coding are two critical areas that are tested during medical billing audit. An under coded bill will result in revenue loss and if it happens on a consistent basis it can cause substantial financial loss to the healthcare organization. Over coded bills generate additional revenue and must be returned back to the rightful payer.
If over coding is discovered by the Office of Inspector General (OIG), Medicare will demand the money back or even a hefty fine can be imposed or the healthcare organization can be put on the OIG pre-payment review. Claims may be denied if the patient data is entered inaccurately. All of these errors can be identified and rectified during the audit process.
With the increase in patient payments, the payment cards and bank accounts of patients are exposed which increases the risk of data breach. Payment card data breach can lead to high financial and reputational loss for the healthcare organization which can result in loss of business and bad publicity. In a sensitive industry like healthcare, when data privacy of patients is compromised, it can affect a large number of people.
Adherence to rules and regulations laid down by the Health Insurance Portability and Accountability Act (HIPAA) is critical for enhanced security of patient’s data as fraudulent activity can be effectively prevented by HIPAA before, during and after the claims process. In the healthcare system, HIPAA establishes clear guidelines between parties with regard to electronic transactions and electronic record keeping. For enhanced security, it mandates people who carry out medical billing to make use of Electronic Health Records (EHR) systems. Patient’s Health Information (PHI) must not be shared as per the privacy rule of HIPAA.
The ability to communicate patient health information electronically in an efficient manner is interoperability. The top priority of a healthcare organization must be the interoperability of EHR as it allows the organization to streamline various internal processes including medical billing. If a healthcare organization has an EHR system that includes medical billing, it must make sure that the system communicates with other internal systems or other office’s systems.
The billing department will be immensely benefited by the interoperability between systems as the information about patient care can be exchanged seamlessly. When information such as health history is requested by insurance carrier, access to the entire patient history allows the billers to get payment more quickly.
Technological capabilities of billing software programs and Electronic Medical Records (EMR) are continuously improving with each passing day allowing most of the medical billing functions and decisions to be automated. There are various medical billing programs that offers automated claims edits, eligibility checking and charge entry. Healthcare organizations usually make the mistake of employing full time equivalents (FTE) to handle functions which otherwise could have been easily handled by automated medical billing program.
Reputed healthcare organizations work really hard to stay on top of the latest medical technology and research so that they can take care of their patients in the best possible way. A similar approach must be followed by them to take better care of their business. One way to effectively leverage the best practices of medical billing is to employ the expertise of a professional medical billing outsourcing service provider. This can allow the healthcare organization to reduce operational costs, accelerate the pace of revenue generation and most importantly increase the efficiency delivered by the healthcare system.