brave new billing worldThe medical billing industry is in the midst of a sea change, which means tremendous opportunity for those who understand what’s coming and prepare accordingly. For that, we need to look at where we’ve been (2011-13), where we are now (2014), and where we’ll be in the next couple of years—for five key areas.

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.

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.

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.

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.
Overview of PracticeSuite Medical Billing Software

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Last Updated on December 17, 2013