The Future of Medical Billing in 2019: 5 Trends You Should Consider Now

2018 has been an overwhelming year for healthcare providers. We have witnessed patients become one of the biggest payers, giant leaps in automation and artificial intelligence in medical billing, the shift to value-based care, and the rise in outsourced medical billing. It’s more important than ever to embrace these changes in a way that benefit your revenue cycle. So what is a new trend in medical billing and coding? Let’s discuss them all, how to take advantage of healthcare trends, and the future of medical billing strategy in 2019.

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The Patient Payment Experience

It sounds like a bad TV documentary, but make no mistake that patients are beginning to hold their healthcare provider to the same expectations as they do their favorite retail stores, especially when it comes to medical bills. Consider this: A customer walks into a clothing store. He picks up a shirt, reads the price tag, and decides whether he wants to make the purchase depending on the price. He then takes the shirt to the register and pays instantly and conveniently. That’s payment transparency and convenience of pay at their simplest forms. Yes, it’s more complicated than that for providers, but there’s a lot we can learn from the retail industry. We now live in a world in which anything you want or need is probably just a few clicks away. With that in mind, physicians need to consider how patients are treated through the collection cycle. They want to know (if possible) how much they’re responsible for paying upfront. They want a convenient way to pay, and ease of mind that if they can’t pay for their medical bills in full, they will have the option to pay over time. Remember, 65% of patients are open to switching healthcare providers who provide a better payment experience.

Considerations - Now more than ever, providers must engage patients in a consumer-friendly manner and equip billing staff with payment tools that create convenience. Consider all parts of the billing cycle, from pre-visit to collection. Estimation tools provide patients with a snapshot of how much they owe out-of-pocket. This creates benefits on both sides: The patient won’t be blindsided down the road by a surprise bill, and you increase the chances of collecting by building trust. 80% of consumers prefer to pay their medical bills through an online channel, so consider an online payment portal that allows patients to pay their bills conveniently, even from their phone. For large balances, having the option to pay over time is a huge game changer for many patients. Offering a payment plan gives patients more leniency in when and how much they pay at once, so they feel more in control. For you, it means another step towards streamlining your collections and increasing revenue. Don’t forget: more importantly than these tools is how your staff interacts with patients every day. Ensure that billing staff is trained properly to answer all questions that patients may have about their balance and the solutions you provide. You can read more about improving the patient payment experience in our new white paper.

Automation and the Future Trends in Healthcare for Medical Billers

Medical billing is moving in the direction of absolute automation. With companies banning together to create end-to-end revenue cycle automation for providers, it’s hard to deny the cost and time savings that come with it. The question that many medical billers may be asking themselves right now is, “Will automation replace my job?” Automation allows medical billers to work smarter and faster, alleviating manual processes that can severely delay collections, like claims processing. In some cases, automation built into medical billing software can completely take over tasks typically performed by billing staff. However, this allows staff to focus on the one thing automation can’t do, interact with patients. How many times have you called a support line or tried to pay a bill online, only to receive an automated message on the other end, and became frustrated that you had to go through several steps to talk to a real person? Software can’t show empathy and it can’t have a conversation with people. Patients need that interaction through the payment process, which is why the patient experience is so important.

Considerations - This is a great opportunity for providers to enhance their billing process from all sides. While automation takes over manually intensive tasks like duplicate billing, incorrect modifiers and inaccurate patient information, billing staff can strengthen their skills in medical insurance and patient collections. Possessing the ability to navigate insurance IVR systems, communicate with insurance representatives, and correct claims denials for resubmission will be essential to collecting outstanding patient balances. As mentioned before, clearly communicating patient financial responsibility and coming together with patients to find a payment solution is equally as important. Patients should walk away feeling confident in the ability to pay off their medical bills.

MIPS Reporting via Registry vs. EHR

With the 2018 QPP Final Rule in place, your method of reporting on MIPS can help determine if you will achieve your quality and revenue goals (If you’re unfamiliar with these terms and bill Medicare, please visit the CMS website here.) There are now multiple approaches to reporting: MIPS Registries, Qualified Clinical Data Registries, claims-based submission, EHR submission, Web Interface, and the new CMS attestation portal for reporting Advancing Care Information and Improvement Activities. It’s enough to make your head spin, as if MACRA wasn’t dizzying enough. Many providers have chosen the Registry or EHR route for a variety of reasons.

Considerations - EHRs can be used to store and report quality measure data. Reporting using an EHR can benefit providers in terms of cost savings and is also ideal for providers who don’t want to implement and learn a new system to report. If you choose to report using EHR, know that someone on staff will likely need to invest time understanding submission requirements to report accurately for reimbursement. If you’re a provider with only primary care doctors, you may find it easier to use EHR since the most common primary care measures can be found in some EHRs. Be sure to do research on requirements for the current year and what features your EHR offers to meet those requirements.

Many providers connected to specialists choose a Registry to report. This is mainly because Registries provide access to 249 measures across many specialties, compared to 53 EHR measures, 74 claims-based, and 15 web interface. Remember, the more measures you have access to, the more opportunity to increase your reporting score, resulting in higher reimbursement. Many registries also include dashboard reporting, so you can identify gaps in performance.

The New Wave of Artificial Intelligence

The majority of artificial intelligence (AI) applications and use-cases for medical billing generally fall under the category of Computer Assisted Coding (CAC). Big players like 3M are using machine learning and Natural Language Processing (NLP) to automatically recognize and extract data from medical documents for proper coding and billing. Now that this technology is becoming more familiar and accepted by the industry, the next generation of AI is coming to address a different part of the revenue cycle, patient collections. This type of AI is, in large part, is a discussion among healthcare leaders. It’s a suggestion that revenue cycle management will be supported by AI to empower patients and billing staff. Jeff Hurst, Senior Vice President of RevWorks at Cerner, told Healthcare IT News, "Leveraging AI, healthcare technology will be positioned to further the work to reduce the cost to collect in registration, scheduling, charge capture, health information management, and billing and collections.”

Considerations - Hurst is certainly onto something. With the rise in patients on high-deductible health plans and the growing challenges for providers to collect accurately, there’s a giant opportunity gap that AI has the potential to fill. Consumerism and patient satisfaction have already impacted the industry. Now, medical billing solution companies are making efforts to become first-movers in improving collections and the financial experience with AI.

From a provider standpoint, don’t be afraid of the possibility. The term “AI” can be daunting and confusing, so conducting thorough research will allow you to discover what solutions are available and realistic for your organization. A common misconception is that artificial intelligence applications that exist only improve coding. There are AI solutions that also verify and correct patient demographic information, customize billing statement releases, and notify billing staff automatically when a patient should be offered a payment plan.

In-House vs. Outsourced Medical Billing

The medical billing outsourcing market is expected to reach $16.9 billion by 2021. It’s no surprise that many providers are choosing to outsource because of changing healthcare regulations and the growing risk management and compliance concerns associated with in-house billing staff. Both methods have their benefits and drawbacks, so it’s up to the provider to weigh the differences carefully – both in terms of cost and operational factors – to decide which approach makes sense.

Considerations - Whether you're a brand-new organization or an established practice thinking about making the switch, the right answer involves analyzing and taking inventory of what truly determines the need for in-house or outsourced medical billing. Ask yourself the following:
  • Are you a new provider?
  • Do you have high staff turnover?
  • Are you hands on when it comes to financial operations?
  • Do you prefer staff to be readily accessible?

Are you a new provider? New providers have a myriad of factors to consider when launching in hopes of acquiring patients and becoming successful. Outsourcing can relieve one of the most daunting aspects of starting new, leaving more time and effort to focus on patient care.

Do you have high staff turnover? When a skilled billing specialist leaves, many practices have no choice but to fill the vacant spot immediately or else revenue may be compromised. Each new billing staff hire requires education and training, on top of being responsible for keeping up to date with regulation changes. The learning curve for a new hire who is unfamiliar with a practice’s processes can be quite steep. It may take weeks or months for them to get into the swing of things, which leaves a lot of room for error. Unless your practice is large enough to require a billing department with employees of varying skills levels, there will almost always be enough turnover to create major issues. Also consider that you must cover work for staff members who are sick or taking vacation. Outsourcing your billing can alleviate the stress of turnover and save money in salaries.

Are you hands on when it comes to financial operations? Unlike an office environment, outsourced billing staff will not be readily available to your management team. Many providers are comfortable with this lack of control of medical claim operations, but many prefer to keep it closer to home. Especially when trusted and long-term employees are handling the revenue cycle, some providers prefer being hands-on through in-house billing.

Do you prefer staff to be readily accessible? If issues arise, many providers prefer to walk over to the billing department and discuss the issue instead of calling someone who works for an outsourced company. In terms of convenience, having in-house billing staff accessible is a major advantage.

The time is now to begin planning for 2019, and with so many new trends emerging, it’s important for healthcare leaders to embrace these changes to find themselves at the forefront of the industry.

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