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Medical billing

As healthcare systems brace for the present and future challenges, the reality lies in reassessment. Reviewing the system involves a check on system efficiency, operational capacities, and billing accuracy. Patient needs require accurate and efficient billing processes, which can be achieved through billing automation. Automation in healthcare is only complete when it is efficiently implemented in medical billing processes. This aspect of healthcare automation really begins after the patient leaves the clinic or hospital. Healthcare reimbursement from insurance companies is solely dependent on the efficiency of billing automation. Overall, healthcare revenue cycle solutions are the lifeblood of automation in healthcare.

What is the Medical Billing Process? 

Medical Billing Process

Medical billing processes are not performed or dependent on a single entity. It involves wholesome participation across the entire healthcare organization. Specifically, billing automation in healthcare must involve the billing department and the administrative department, and the clinicians themselves. The complexity of the medical billing process and procedures arises from the fact that the payment is usually not made upfront. Much unlike the usual process of immediate payment for a service, the U.S. healthcare system requires to follow up accuracy with medical billing codes. Automation of healthcare in medical billing requires consistent association with healthcare insurance companies as a key component.

Medical billing processes involve every step of association between the patient and the healthcare organization. Beginning from the pre-registration process, wherein the patient schedules an appointment, up until the point of completion of visit or consultation, the online medical billing solution is a comprehensive assessment. The medical billing process and procedures then involve assessing the patient’s insurance plan, co-pay options, insurance eligibility, and coverage options. After the patient’s visit, medical billing codes are accurately applied, which translate into payment reflections. Reimbursement is then received based on the accuracy of medical billing codes. Healthcare automation requires HIPAA compliance with medical billing online. Upon approval of the claim, healthcare reimbursement is received. This process can be significantly simplified through automated healthcare solutions.

What Is The Current Healthcare Billing Scenario?

Healthcare Billing

As infections across the nation grow with the Covid-19 outbreak, patients’ health and safety lie as the top priority in medical care. The covid-19 pandemic has also caused a massive outbreak of unemployment and financial insecurities, which directly impacted the medical billing process. Covid-19’s impact has made its way across the entire medical billing process and healthcare payment system. Medical billers and coders have to now deeply analyze the best options for enhancing the patient experience.

The medical billing process is faced with the challenge of adjusting to covid-19 billing requirements, avoiding surprise medical billing, and enhancing the medical billing process through billing automation and custom healthcare solutions. Medical billing policy has to adapt to the present times and remain geared to address healthcare organizations’ economic losses. This is caused due to the sudden decline in outpatient and non-urgent treatment procedures.

“According to an Inbox Health Survey of 1200 medical billers, 21% of the respondents forecast that 10-25% of their practices may close their practice within the next six months. Another 18% of respondents said they expect that 25-50% of their practices will shut their doors. Congress has provided over $100 billion to help medical practices, hospitals, doctors, and other healthcare professionals in the Public Health and Social Services Emergency Fund through the Coronavirus Assistance, Relief and Economic Stability (Treatment) Act, or the Provider Relief Package.”

During Covid-19 times, billing automation requires innovative strategies of case management to surpass the challenges of revenue loss, among recession and unemployment. The healthcare industry has been faced with a plethora of hurdles and will need to adopt agile technologies and best practices to remain afloat with the medical billing and coding process. Robust specialty billing practices need the hour to address the losses in the revenue cycle and continual challenges on medical billers and coders.

How To Reduce Overall Billing Costs?

The medical billing and coding process is one that has the maximum impact on the healthcare organization, as it lies at the core of generating finances. From appointment scheduling, registration processes, billing, and coding, billing automation runs through the entire lifecycle of the caregiving process. Healthcare automation, therefore, involves reducing the overall billing costs of the clinic or hospital. The medical billing and coding process depends on the payer and plan for the incoming funds, which directly impacts reimbursements in healthcare.

In the present time, 9% of claims are denied, 3.3% of provider revenue remains at risk, and the provider is paying an average of $118 per claim. This totals to $8.6 billion in administrative costs each year. Almost 90% of these denied claims can be prevented through agile billing automation in the medical billing and coding process. When custom medical coding solutions are deployed, the patient’s demographic and other related information are automatically updated. This increases coding accuracy to a large extent. When a healthcare organization decides to automate medical billing, including ICD 10 coding solutions, the medical billing process is automatically poised to increase its efficiency and decrease its cost of denied claims and other errors. Inaccurate patient information is the key factor that contributes to denied claims. The problem is fairly easy to solve. Billing automation is the solution.

Medical billing management, at the initial stage, involves an analysis of the number of denied claims. If the percentage of denied claims is below 5%, you can rest assured that your medical billing process functions reasonably. However, if the number of denied claims is above 5%, it is time for healthcare providers to re-examine the medical billing and coding process. EHR data must be incorporated into the billing automation process. Revenue protection must remain the priority. Timely completion of documentation and HIPAA compliant practices are another prerequisite toward maintaining financial health.

How To Improve Overall Billing Efficiency?

 Billing Efficiency

We can’t stress this enough. Billing automation lies at the crux of the health of medical billing systems. During the present times, caregivers need to carefully evaluate the need to automate medical billing for overall productivity and efficiency. Process automation, along with centralized billing practices, should be incorporated within the hospital management system. Medical billing management solutions need to be deployed to enhance revenue cycle automation and reduce the administrative burden on medical billers.

Telemedicine is now the center point of healthcare practices, and medical billing systems must fall in line. More than a stop-gap arrangement that addresses health care needs during the pandemic, telehealth is now envisioned as the future of healthcare. Medical billing processing, medical invoicing, and billing software need to be consistently aligned to offer medical billing from home options. As caregivers focus on innovative ways to offer care to patients, medical billing software needs to fall in line to offer automated and hassle-free billing solutions. As healthcare billing and coding are frequently updated, medical bill processing must work in an automated fashion to adapt. Medical billing from home is the need of the hour.

Billing software, such as medical claims management solutions and remittance software solutions, can be incorporated into the medical billing systems for all-rounded workflow efficiency.

How To Boost Billing Profits?

“The American Medical Association estimates that some payers suffer rework on over 20% of claims due to human data entry errors.” These errors result in denied claims and revenue loss. Reimbursement in healthcare is adversely impacted through this, and reprocessing claims is a complex and time-consuming task. Medical billers have a tedious task at hand due to the complexity of medical billing processing. The human error component is another factor that contributes to this number. Incorporating quality medical billing software programs can mitigate human error challenges to a large extent.  

Medical billing management solutions address the root cause of this problem by automating the claims processing procedure and ensuring the accuracy of patient information and demographics. Furthermore, process automation targets a higher point of success through its wholesome approach across caregiving’s entire life cycle. Healthcare billing and coding are only one dimension of the medical billing software programs. Medical billers are put at ease through comprehensive process automation. Independent medical billing processing is achievable and desirable.

How To Choose The Right Medical Billing Software?

Medical Billing solutions

The right medical billing processing software is not a one size fits all solution. Every healthcare organization will have its own specific needs of medical invoicing and other requirements that will need to be assessed and identified. However, there are a couple of indicators that can assist in the selection process. It would be prudent to opt for an all-rounded solution that uses data for the healthcare organization’s multiple purposes. From appointment scheduling, eligibility verification, clinical record documentation, clinical procedures, prescription requirements to medical billing and coding, medical credentialing, and claims management – a wholesome solution is usually the more productive and accurate one.

Another important aspect is the capacity of the software to identify and resolve the areas that require attention and improvement. Therefore, billing automation is a comprehensive merging of all other caregiving activities, which will ultimately ensure higher reimbursements and a greater patient experience.

Conclusion:

The right medical billing processing software is not a one size fits all solution. Every healthcare organization will have its own specific needs of medical invoicing and other requirements that will need to be assessed and identified. However, there are a couple of indicators that can assist in the selection process. It would be prudent to opt for an all-rounded solution that uses data for the healthcare organization’s multiple purposes. From appointment scheduling, eligibility verification, clinical record documentation, clinical procedures, prescription requirements to medical billing and coding, medical credentialing, and claims management – a wholesome solution is usually the more productive and accurate one. Another important aspect is the capacity of the software to identify and resolve the areas that require attention and improvement. Therefore, billing automation is a comprehensive merging of all other caregiving activities, which will ultimately ensure higher reimbursements and a greater patient experience.

References:

https://1stproviderschoice.com/significant-impact-of-the-covid-19-pandemic-on-medical-billing/

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Originally published January 8, 2021 6:05 am

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