Everyone in healthcare knows receiving payments is hard. They know it’s not just one thing that makes it hard. It’s all the small, routine tasks that are never reported, all the conversations, and all the files moving between systems that are never mentioned in your monthly report that determine your budget and help to make smarter business decisions.
Industry experts have been saying for the past five years how a surge of automation is leading to the next big change in healthcare. One example we meticulously follow is the day to day operations and financial impact of automation on medical billing and practice management. In this article, we will explore some of the challenges associated with medical billing in practice management, as well as the benefits of automating your current practice management system.
current practice management system
Practice Management Workflow
- Patient Scheduling and Registration -- setting an appointment via an online portal or with the front desk; providing demographic data, updated contact details, and payer information
- Eligibility Check and Demographic Verification -- including pre-authorization, instantly highlights issues with payer compatibility. Resolving these issues prior to a patient visit can reduce your denial rate later
- Coding and Review -- translating medical diagnostics, equipment and procedures as billable records while reducing instances of denials due to incorrect or missing information
- Collection of Co-pay/balance -- the fixed amount received from a patient for a service immediately after the appointment or soon after
- Claim Management -- creating, validating and submitting a claim to a clearinghouse or payer, either electronically as an e-claim or manually as a paper claim
- Correcting Errors/Denials -- systematically addressing the causes of why a claim was rejected or denied before resubmitting it for consideration
- Payment Posting -- posting payments into into the respective patient accounts against a particular claim to reconcile them
- Patient Statement and Communication -- sending patient invoices and reminders via their preferred method of contact, either over the phone, through email, or as a printed statement
- Analytics/Data Analysis -- comprehensive financial dashboards can help you and your team analyze the performance of your practice at a single glance
Challenges Associated with Medical Billing in Practice Management
Obstacles of implementing a practice management software include a lack of time to set up the infrastructure, lack of expertise, and system privacy/security:
- Security and privacy of web-based or cloud-based practice management is a concern with software hosted on another company’s server. Since this software is available from anywhere with a web connection, it’s also vulnerable to attacks by cybercriminals. Consider the financial and reputational risks related to use of third parties for core services. If security is a priority, check out ImagineMedFMTM VPN, encryption, and user authentication.
- Billing and collections, charge capture and coding was rated as one of the top risk areas for healthcare organizations in 2019. While outsourcing medical billing is a common method for offloading organizational tasks, lack of visibility into controls of third-party systems can result in lost revenue and lower claim resolve rates. Furthermore, outsourcing occasionally requires careful supervision to ensure business and patient experience standards are upheld.
- Value-based care holds a healthcare organization accountable for both the clinical and financial outcomes of a patient’s care. 36% of hospital system executives are exploring practice management systems that will allow them to streamline financial and clinical systems. This challenge increases exponentials for multi-specialty practices whose claims are spread out across multiple billing systems.
- Staff turnover and retaining affects provider workloads, patient outcomes and costs when managed using manual billing systems. Some doctors will choose employment with a healthcare system in lieu of the clerical responsibilities associated with running their own practice. For those who remain independent, owners are faced with the challenge of providing the necessary training and resources their staff needs to manage their day to day.
Benefits of Automated Practice Management Systems
Products like ImagineBillingTM built for high-volume, complex medical billing can be configured to your current practice management workflow while automating it in the following ways:
- Real-time validation of demographic information, insurance eligibility checking, and pre-authorization makes quick work of top sources of claim denials.
- Claim generation, scrubbing and submission automatically looks for issues in your claims before they are sent to your clearinghouse or payer.
- Electronic Remittance to automatically post insurance payments and reconcile balances much faster than can be done manually.
- Real-time analytics and business intelligence gives you centralized access to business information and status reports for making smarter business decisions.