Exceeding expectations for electronic billing

March 1, 2011

You may see more cash through the door and even improve communications with all parties involved when you implement the right automated workflow.

Scott Law

The past five years have brought a drastic rise in health insurance premiums. Consequently, the recent increase in healthcare costs is making it more difficult for insurance providers and physicians to manage the high-maintenance task of collecting money from patients and filing reimbursement claims. While it has taken quite some time for physicians to move from the paper-based U.S. healthcare system, they are increasingly recognizing the benefits of a technology-based system that allows records and billings to be handled electronically — for both patients and their practices.

You will benefit from a paperless solution

Many physicians are troubled by the enormous amount of ongoing paperwork and difficult practice environments. In fact, 30 percent of all healthcare claims are inappropriately paid, and half of those claims are never followed up. As a result, these back-office errors are coming out of providers' pockets. As physicians spend the majority of their days seeing patients, they simply do not have the time to follow up on unpaid medical claims.

The recent surge in physicians turning to electronic billing systems is in large part due to an increased understanding of the advantages of a paperless office, federal mandates and delays in the processing of paper claims. Additional benefits of utilizing a high-tech medical billing system include enhanced patient care, decreased lost or misplaced paper documents and a significant reduction of cost in both billing and employment.

With efforts to reduce and eliminate denials, healthcare executives are leaning toward automated workflow. Advancements in software are prompting the use of technology to detect inconsistency in billing, and some medical billing providers have created software with the capability to alert appropriate claims to personnel and patients. This even allows billing managers to measure the efficiency of their staff.

Typically, 80 percent of payments are hassle-free to collect on. However, the other 20 percent pose challenges and require extra time and attention from the billing staff. These claims require an automated workflow that drills down into the problem, as well as integrated document imaging that shows the necessary documentation and allows for appropriate follow up with the insurance payors.

Current healthcare system

The time to act on electronic billing is now. With self-pay money being the most difficult to collect and physician reimbursement on the downward slope, healthcare providers can handle all of the paperwork with technology.

By investing in electronic information technology systems, medical records can be sorted and processed more efficiently and with minimal human errors. Without the hassle of thousands of papers, costs can be reduced if claims are processed electronically.
In addition, with the option of either outsourcing billing services or performing billing in-house, providers have access to the best collections tools to turn denials into revenue. Billing software is designed specifically to help physicians accomplish better patient care, enhance workflow management, eliminate unnecessary labor, track productivity and get cash in the door.

By automatically identifying charges that have not been paid or require further attention, the billing software ensures maximum payment with little effort. Electronic billing systems allow patients to pay online, receive insurance updates and set up payment plans that work for them, but still meet the requirements of healthcare providers.

Although self-pay money is the most difficult and expensive money to collect, it is unreasonable for this added expense to be passed down to the physician. Today's technology enables patients to make credit or debit payments online and allows billing offices to receive online insurance updates. Perhaps the biggest benefit is the success in terms of communication. These tools can fully integrate with electronic billing software and open a dialog with everyone involved in a medical encounter. By getting everyone involved in the billing process, interaction is successful and no time is wasted.

In-house vs. outsourcing
Whether a practice decides to license medical billing software, access it through an ASP (application service provider) model or outsource accounts receivable entirely, third-party billing solutions will help reduce labor, improve efficiencies and increase revenue.

If an administrator recognizes that he or she has the right staff to enhance the process, then licensing technology is an excellent solution. However, if an administrator is having difficulty hiring good collections staff, then outsourcing accounts receivable may make the most sense.
Many healthcare executives have made the choice to outsource so they can focus on their primary goal of providing their services and treating patients without getting distracted by automated billing systems. However, today's technology gives providers complete control and access to their data by making it accessible online.

Choosing to keep billing in-house due to economics or staffing requires technology to help provide an effective and efficient billing system. Modern software can speed up the process and utilize fewer employees while still getting the same amount of work completed. Staffing costs can be reduced by 20 to 40 percent.

Necessary technology in today's economic environment

Patient portals

The increasing popularity of healthcare savings accounts (HSAs) and other high-deductible plans is being felt in the medical billing business. As more consumers become responsible for a larger portion of their bills, it is essential to provide patients with easy access to make payments. A customized secure (SSL) Web page that is accessible via a provider's Web site allows a more efficient communication stream between patients and the billing function. Patient portals improve access, eliminate labor and proactively communicate with patients. They allow patients to review their accounts, update their demographic/profile information and make payments online.

Financial decision support systems

Robust reporting modules enable healthcare executives to dig deep into their system information and effectively data mine, drill down, chart and analyze data in a robust and meaningful way. Financial decision support systems can include analysis cubes, representing best practices for viewing and digesting information. In addition, some offer a “wizard” capability, allowing individual users to create their own cubes, analyses and reports. Decision support systems provide access to information that enables users to proactively manage their businesses, rather than reacting to outdated reporting materials.

Outbound dialers

As more consumers become responsible for a larger portion of their medical expenses, it is essential to provide your patients with easy access to make payments. Automated phone technology can make multiple automated and customized phone calls to patients, allowing them to obtain balance information, update insurance information and make payments without needing to speak to a live attendant. All phone calls are recorded and are attached to the patient account. A patient receiving an automated call can be connected to an account specialist to take his or her HSA payment or to set up a payment plan. All automated phone calls have customized messaging depending on the severity of the outstanding account and client-specific direction.

Executed correctly, these technology advancements are powerful tools to help practices handle billing and record maintenance in an electronic format. Regardless of in-house or outsourcing, modern billing solutions are intended to help clients use the technology and software to meet their specific needs and improve patient care while minimizing denials.

Scott Law is president and CEO, Zotec Partners.
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