Medical billing and collections management is considered to be the major function of any healthcare organization. For the healthcare revenue management cycle, clean claims are ensured to the payers and reimbursement is collected promptly. It is a very important part of running a hospital or medical practice.
In 2019, Data has revealed that medical billing and collections will pose a great risk to healthcare organizations. Most healthcare organizations have lost completeness as well as the accuracy of their billing cycles, lost their revenues, and lack visibility on the control on the third-party billing and collections providers.
Recently, researchers have observed that incomplete and inaccurate billing, has resulted in increased claim denials, lost reimbursement, and costly reworking of the claims. Most of the healthcare organizations are resorting to the services provided by third-party vendors and outsourcing their medical billing and collections. But everything comes with a price. The hospitals will still need to manage and have stringent control over their third-party vendor’s performance to get clean and timely claims.
Easy Patient Access is a Big Problem
In 2019, patient access has also posed a great risk to healthcare revenue cycles. There should be a straight-forward control over the access of patients to various functions such as patient scheduling, registration and admission process. Many researchers are of the view that rigorous control over these processes will help in minimizing the risk of accounting as well as billing-related issues, poor patient satisfaction and lost revenue. In addition to this, information obtained during the preregistration, scheduling and registration process should be accurate and complete. The whole process should involve checking medical necessity for outpatient services and an estimate of the cost as well as a patient liability should be provided at the earliest.
Prior Authorization is Another One
Not only this, but healthcare organizations should necessitate the need for prior authorization requirements and insurance verification this year. Proactively checking for prior authorization and verifying insurance will help in preventing any disruptions in the billing processes. Prior authorizations are at their peak. According to a poll estimate in 2017, prior authorization requirements have risen tremendously.
Healthcare provider organizations will also need to connect the patients with the best financial counselors in the industry and also collect the patient’s financial responsibility upfront. The trend of patient financial responsibility is growing in the healthcare sector. Therefore, it is the responsibility of the financial counselors to visit all the uninsured patients before their discharge and the financial counselors should help the patients in identifying and applying for the insurance. In addition to this, they should also offer any other healthcare assistance to the patients to avoid any sort of billing-related issues later on.
Many researchers are also of the view that provider organizations should focus on eliminating the reasons behind denial management. They should try to eliminate this reason throughout their organization so that the claim process could be managed smoothly through all the departments.
Also, they need to take care that if they have implemented any high-cost procedures and services in the billing process and claims, then they should be implemented properly, accurately and timely to avoid any inconvenience.
Getting Hold of the Medical Billing Process!
Most healthcare providers are adding practice management software to significantly reduce their administrative tasks such as scheduling, registration and appointment reminders. While others are outsourcing their billing processes altogether. Also, many practitioners are exploring a relatively new concept of revenue cycle management. Organizations following the concept of RCM have witnessed a reduction in billing issues as compared to those struggling with in-house billing costs and procedures.
In-house billing mechanisms could be benefitted from a properly integrated practice management software while handling most of the billing procedures manually. The need of the hour is that someone responds to the rejected and denied insurance claims timely so that regulatory changes could be implemented effectively.
A comprehensive and effective revenue cycle management process will remove the burden from the medical team and help in making timely reimbursements. A revenue cycle management provider handles payment collection from the patient and claims from insurance companies- that can be a challenging task for the medical practitioners. An RCM can help in avoiding issues even before they occur.
In conclusion, a correct, complete, accurate and timely implementation of procedures can solve the billing issues related to medical industries.