1. Eligibility verification and benefits authorization
Where we were (and some still are)
Eligibility and benefits authorization was always done over the phone, a laborious process that was often neglected or done haphazardly.
Where we are
Unfortunately, not much has changed. Phone-based, manual procedures are still the norm in most practices, a time- and personnel-intensive process.
Where we’re going
With a comprehensive electronic billing/practice management system, patients can be instantly verified, and detailed patient benefit reports are available with a mouse click, freeing up staff for other tasks.
2. Billing
Where we were (and some still are)
Paper-based billing held the potential for errors at every stage. Data re-keying led to copious errors.
Where we are
Electronic billing software has advantages over paper (such as front-end edits), but a lack of integration with other systems leads to inefficient, disjointed workflow.
Where we’re going
With an end-to-end, unified solution, all departments (clinical, administrative and billing—including a third-party biller) use the same system. Workflows make sense, error rates go down, and efficiency increases. The overall healthcare trends of the decade continue to hold true as we enter the new decade– technology, automation, and cloud are forerunners to your billing practice’s success.
3. Claim corrections
Where we were (and some still are)
Paper-based systems meant claims errors were only uncovered when the claim was denied. Claims with multiple errors went through the submission/denial process multiple times.
Where we are
Legacy electronic billing systems help practices avoid patient-data errors, and clearinghouses catch many coding issues, but the process still takes days or weeks.
Where we’re going
Next-generation systems provide front-end edits, claim validation, and multiple levels of status information. Billers can customize all claims-related alerts, and the information for claims follow-up is available on a single screen. We’ve discussed tips and tricks to ensure the least amount of claim rejections, it’s always good to brush up especially head into a new year.
4. Role of the biller
Where we were (and some still are)
The biller was essentially a data processer, performing re-keying and faxing functions. Third-party billers had difficulty making the case for outsourcing.
Where we are
As long as they’re using traditional billing methods, even top-notch billers still spend a great deal of time on manual, low-level tasks and tend not to be seen by physicians as a value-add.
Where we’re going
Simple tasks are performed electronic billing/practice management system—when a physician completes an encounter and saves the chart, the software automatically pulls the diagnosis and CPT codes and creates a charge. The billing department or third-part company has complete control over the billing module and is highly proactive, performing high-level, value-add activities to lower denial rates and decrease days in AR.
In 2021, medical billing outsourcing is at an all time high. Reports predict that the market size is expected to reach 23 billion dollars by 2027. Claim submission and other tasks are being transferred to automation. Further, the role of the biller is even more emphasized as the COVID-19 vaccine gets distributed, pushing billers to stay on top of new CPT codes.
5. Reporting and transparency
Where we were (and some still are)
Buried in piles of paper that, if misplaced, led to non-payment. Payables were lower due to patients seen but never billed for and co-pays never collected.
Where we are
Some tasks are performed and tracked electronically, but the schedules may still be paper based, clinical notes may be in Word rather than an EHR, and the practice manager may not have access to key billing information.
Where we’re going
End-to-end, cloud-based systems mean up-to-date patient, billing, and financial information is instantly available from any device. The system alerts the appropriate department about lost superbills, un-paid co-pays, claims denial rates, AR levels, and
Perhaps the most exciting aspect of the near future is eradication of the blame game. In the past, when a physician or practice manager saw a revenue dip or noticed a high debt level for a particular payer and demanded an explanation, no matter what explanation the biller gave, it sounded like a lame excuse.
Today, with a sophisticated, end-to-end system, there’s no need for blame or excuses. Top management can see the status of every claim, denial levels by payer, common rejection causes, AR status, and cash flow levels. Instead of playing the blame game, everyone can work together to identify problem processes and fix them.
In 2021, CMS is rolling out the Hospital Price Transparency Rule that went into effect on Jan 1. This rule is based around helping Americans understand and know the cost of a hospital service before receiving it. Hospitals will be required to provide clear accessible information in a readable file or a user-friendly shoppable service format.
