Addressing these 4 common hospital billing services challenges can improve your healthcare revenue cycle. Medical billing services are the backbone of healthcare revenue cycle management. However, hospital practitioners experience significant challenges with efficiently and accurately billing patients and payers for the services they perform.
The medical billing process can be a pain point for some small and medium-sized hospitals. As it involves an array of healthcare stakeholders and each step to getting paid depends upon the previous interaction. Hospital owners must communicate across departments and payers to ensure that crucial information is properly captured and shared in each step of the process.
Despite the long and winding journey, effective medical billing is essential for optimizing revenue cycle and reducing days in accounts receivable.
In the section below, there are four most common hospital billing services and their solutions that would help providers to streamline and improve the process.
- Incorrect Information Leads To Reimbursement Delays:
The medical billing process usually starts at the initial point when the patient comes to the reception of the hospital or physicians’ office. The front-desk staff collects information from the patient that will lay the information for hospital billing and payment collection.
It is essential for hospital revenue cycle management to collect accurate information from the start with patient scheduling and patient registration. This information provides the groundwork by which claims can be billed and collected efficiently and effectively.
The main objective of the hospital billing process is the claim submission and reimbursement collection. However, it is only possible if you get the information upfront in as pleasant a manner as possible. It also prevents stress for the patient and family if the claim is processed and cleared in a judicious manner.
Providers should input this information into the billing system correctly. Moreover, it is also a key point that front-desk staff also verify health insurance eligibility status and coverage plan of the patients.
According to a recent survey, it has been reported that incorrect information is the reason for claim rejection in most cases. About 8 % of claims are rejected due to eligibility problems.
The survey also revealed that providers were not collecting adequate information regarding eligibility that caused a significant increase in claim denials and rejections.
Healthcare organizations should regularly retrain front-end employees regarding patient information and remind workers to verify a patient's eligibility for each appointment.
- Ignoring the patient’s financial responsibility:
The total reimbursement collected defines the success of hospital billing services. Although, many hospitals have recently experienced lots of issues with collection management and an increase in patient’s financial responsibility.
The increase in high-deductible plans shifted healthcare payment responsibility to the consumer rather than the payer. Hospitals should boost patient revenue and implement such financial responsibilities that include estimating costs of service, informing patients about financial responsibility and collecting some of the balance during a visit.
Now high-deductible plans have forced a lot of patients into a situation where they owe far more money than they used to for the same services before. As new policies have increased patient’s shares so significantly that a lot of physicians have decided that they need to try to collect this at or near the time of service.
Though, with the insured patients, they really didn't know this information about what they owed because it wasn’t a significant amount and a very high proportion of the patients paid when they received their bills.
Therefore, healthcare organizations should take steps to clarify patients' bills in a simple way. The Department of Health and Human Services responded to reports that medical bills were surprising patients due to medical jargon and multiple requests for payments. The federal agency developed a contest that will award several innovators for developing easy-to-comprehend medical bills for patients and simplified medical billing solutions for providers.
- Use of inefficient manual system:
As most healthcare organizations know, submitting a claim involves more than just pushing a button. Providers must engage robust data collection tools, develop effective communication channels between front-end and clinical staff, and streamline denials management procedures.
Claim management is a complicated procedure for the entire healthcare organization, especially as more providers shift to data-driven value-based care models. However, one-third of providers still use a manual process for denial management.
Medical organizations deal with the complexities around submitting claims and the labour associated with managing denials. Most organizations also face shocking hazards that are caused due to manual denial management processes through a vendor-provided solution.
Hospitals can optimize their revenue by automating the medical billing and denial management system in a timelier manner. Organizations who acquire innovative hospital billing solutions can identify the root cause of denials, manage resolutions and reduce write-offs.
Automation can provide a tremendous amount of opportunities for insightful strategies. There are still a number of manual procedures that you have to go through for claim processing. These manual procedures lay a foundation for several errors and inaccuracies. Therefore, automatic claim scrubbers can ensure accurate results from hospital billing services and follow-up work etc.
Hospitals can monitor and improve on key performance indicators including; account receivables, discharged but not filed claims, and case-mix performance.
- Out-dated medical billing and coding:
Hospitals should make sure that their staff is following the rules and regulations associated with ICD-10 implementation. This is the only way to benefit from the hospital billing system. Otherwise, coding inaccuracies will result in a host of problems for the organizations.
Improperly using procedure codes including the incorrect application of the seventh characters for trauma and fracture codes, incorrect codes that drive a diagnostic related group, misidentifying respiratory failures, misunderstanding the use of guidance tools and insufficient documenting devices, components and grafting materials.
If your medical services are being consistently encoded in inaccurate medical codes will likely to an uptick in claim denials. Healthcare organizations should ensure that their services are being encoded according to ICD-10 implementation.
We recommend that hospitals and providers should utilize more influence on improving their medical billing cycle. They should consistently update with the ongoing changes in the medical coding field.
Medcare MSO provides efficient medical billing services to streamline revenue generation. We help practitioners to boost productivity, increase cash flow and recover the bad debt to enhance their financial strength.