Streamlining Healthcare Revenue: The Power of Electronic Medical Billing

Electronic Medical Billing

The capacity to remain financially viable is a problem for many hospitals and healthcare institutions. Health systems are “face[ing] a margin cliff as the aging of the US population combined with lower reimbursement from government payers put pressure on traditional revenue sources,” according to Deloitte.

Nearly $360 billion is spent on administrative costs by American insurers, government health organizations, and medical practices each year. And a sizable portion of those costs is tied to billing-related activities.

Electronic medical billing aims to save expenses, free up time for medical professionals, and boost patient satisfaction. However, many healthcare organizations have been sluggish to implement alternatives to digital billing. These organizations could be endangering themselves. According to McKinsey & Company, businesses that engage in digital capabilities like electronic medical billing may gain a competitive edge, particularly in challenging economic times.

Third-party medical billing companies are utilizing electronic medical billing in addition to hospitals, health systems, and doctors’ offices in order to shorten the revenue cycle, boost patient payments and provider revenue, cut costs, and improve patient satisfaction.

Electronic medical billing: What is it?

Electronic medical billing: What is it

An electronic medical bill or claim is sent to a patient or third-party payer by a healthcare provider or third-party billing organization. (typically an insurance company).

The provider assigns diagnosis and procedure codes to the interaction when a patient visit is complete. These codes aid insurance providers in evaluating the claim and any corresponding coverage. In order to comply with HIPAA’s (the Health Insurance Portability and Accountability Act of 1996) standards for the electronic submission of healthcare claim information, claims are sent to insurance companies via an electronic ANSI 837 file.

Medical claims adjusters evaluate submitted claims and are compensated based on predetermined percentages for each operation if their claims are granted. Returned to practitioners for further information or clarification are claims that are denied.

The act of directly charging patients, whether they are self-paying or insured and have defined deductibles or other out-of-pocket costs, is sometimes referred to as electronic medical billing. To speed up payments and cut expenses, electronic medical billing, mobile billing, or digital billing can supplement or replace a paper billing procedure.

Comparative Benefits of Paper Billing

Comparative Benefits of Paper Billing

The most often cited advantages of implementing electronic medical billing include lower costs and shorter revenue cycle periods between patient treatment and reimbursement. When combined with electronic medical records and other digital efforts, electronic medical billing can have additional positive effects for a practice.

Reduced prices and quicker payments

The financial performance of healthcare providers who switch to electronic medical billing might significantly improve. David Cutler, a Harvard University economist, estimates that the US healthcare system might save $32 billion annually by switching to computerized billing.

There are various ways that switching might be financially advantageous for providers:

A Better Collection

Practitioners frequently believe manual, paper-based invoicing is less relevant and efficient as patients increasingly connect digitally via tablets and smartphones. By switching to electronic medical billing, the revenue cycle can be significantly enhanced. With the conversion to digital billing, this third-party medical billing business, which supports over 400 physicians in Tennessee, raised patient payments by 43%.

Lessening of Administrative Costs

Moving to digital billing removes the need for paper bill storage and lowers stationery and mailing expenses. Staff in the medical office need not anymore print and mail paper bills and follow-up reminders, which also reduces their workload.

Medical Professionals Save Time

Electronic billing relieves doctors of their administrative duties, allowing them to focus on more high-impact tasks.

Efficiencies in operations and administration

Efficiencies in operations and administration

Medical offices can expedite administrative tasks and gain other operational advantages by integrating electronic medical billing as part of wider mobile-first initiatives:

Integration with billing and practice management systems

By eliminating duplicate data entry and producing a single, full patient profile, an electronic billing event automatically updates the patient’s electronic medical record.

Better backup, security, and storage

Manual billing records must be preserved and protected since they are susceptible to theft, mishaps, and disastrous events. (e.g., fires and floods). It is possible to back up and securely archive digital documents locally or remotely.

Greater Detail in Reporting

Practice managers may create personalized reports using electronic billing and connect billing data to current accounting systems.

Lower Coding Error Rates

Billing systems may access patient data from electronic medical records, allowing practitioners to create more precise claims for payment from insurance. Incorrect code entry and re-entering costs from billing sheets are also human faults that are removed by this data exchange.

Patient satisfaction has increased

No patient enjoys getting a bill, but due to increased patient financial responsibility, people now anticipate paying at least some of their medical costs. The fact that this process is offered online can improve the patient experience and increase satisfaction because patients expect it to be both digital and mobile:

Better Interaction

Patients may see their invoices on their cellphones, tablets, or computers, and electronic billing enables healthcare providers to interact more proactively. Customers may frequently pay with only one click because to the prevalence of electronic billing solutions.

More openness

Patients said that 72% of their benefit explanations and 70% of their medical bills are confusing to them. Patients who use electronic medical billing can get more in-depth information about their bills or payment alternatives, access payment plans, and make payments via a special link that is delivered to them through text or email.

Enhanced Brand Recognition

Particularly among younger people, healthcare practices that offer more digital interactions (including electronic billing) are seen as more effective and “current.” To draw in and keep new patients, it is essential to preserve this perception.

Implementing Electronic Medical Billing: How To

Implementing Electronic Medical Billing: How To

Medical practice may experience a variety of effects while switching to an electronic medical billing solution. Healthcare professionals must take into account various concurrently occurring crucial actions. Effective deployment of electronic medical billing will be made possible by careful planning, resource allocation, and monitoring of each phase.

Project Management

Before starting the switch to electronic medical billing, it is crucial to have a thorough project strategy and timeframe. The following components must be in the plan:

  • Establishing objectives and necessary results
  • Identifying important participants and project primes, such as the project manager, the lead super-user (internal specialist), and the lead doctor
  • Putting together a schedule and figuring out project dependencies

Customizing Workflows

Current billing workflows should be documented and examined to make sure no procedures are missing during the transfer. The cornerstone for building, testing, and adapting new processes to enable electronic medical billing is understanding current workflows.

Creating a budget and obtaining funding

When presenting the project plan to business stakeholders, it will be helpful to identify all probable project expenses and to create a preliminary budget. Throughout the project, regular budget changes and updates will be necessary.

Internal Communications and Employee Engagement

The success of the initiative depends on effective employee engagement. The whole crew will stay involved if there is a formal start and then regular updates. All stakeholders will have a better understanding of new procedures and their corresponding duties by implementing a role-based training strategy.

Choosing and Evaluating a Vendor

The process of choosing a vendor involves a number of processes, including:

  • Consulting colleagues in the field of medicine
  • Investigating prospective vendors
  • Requesting suggestions
  • Contract discussions
  • Establishing and carrying out a project strategy with the chosen vendor

Ask for recommendations and case studies when you approach the market. Vendors with enduring ties with their customers and pioneers in patient-centered outreach are more likely to be on the cutting edge of technology that can satisfy these demands and to have a pulse on patient expectations and preferences.

Putting the Solution in Place

Selected suppliers will assist in developing the solution implementation strategy and outlining all essential tasks, such as:

  • Gathering and transferring patient data from the old billing system
  • Validating and, if necessary, modifying the workflows
  • System evaluation
  • Providing user education
  • Testing with a test population
  • “Going live” and system cutover

Protocols for Security Establishment

Strict processes must be documented and followed in order to protect patient data:

  • Implementing HIPAA rules
  • The creation of security rules and related procedures
  • Making a strategy for disaster recovery
  • Establishing a plan of action in the case of a security or privacy breach

Optimization of Solutions

Once the electronic billing system is operational, it is crucial to assess performance in relation to predetermined success criteria. It’s also crucial to get input from stakeholders. Do users of the system encounter any issues? Have business measures (such as income from the practice or collections) improved? What degree of compatibility does the solution have with other current systems?

Regular performance reviews will assist in finding ways to improve and optimize the billing system. Don’t forget to check the What Insurance Does a Social Media Influencer Need?

Can electronic medical billing change the way you practice medicine?

Healthcare is quickly changing to meet new medical advancements, shifting patient expectations, and budgetary concerns. Digital technology “has the potential to transform medicine and the healthcare industry in a sustainable way,” according to Deloitte.

A crucial element of this progression is electronic billing. Electronic medical billing may enhance a healthcare practice’s financial performance while simultaneously increasing patient happiness, especially when integrated with digital patient data.

Careful planning and execution can assist healthcare providers that haven’t made the switch to realize the numerous advantages that electronic medical billing promises. You also check our guide for Cybersecurity Insurance Policy for Small Businesses?

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