Plans of Action for Successful Medical Billing

Written by on September 1, 2017 in Features - No comments

Using and Improving Your Existing Billing System

How effective is your practice’s medical billing? The time has come to put a full stop to any negativity about the billing department! It’s a time for action. Making the most of the given team should be the goal of an administrator. Here is a possible plan of action to consider for increasing the efficiency and profitability of your practice’s medical billing.

A successful model is divided into three main parts.

  1. Process of a successful billing plan
  2. Understands the myths
  3. The key areas to address in the billing process
Part 1: Process of a successful billing plan
  1. Plan & strategize: Have you developed policies in regard to billing and insurance related matters? What is your plan of action for planned cases, surgeries, and unplanned admissions? Do you have pre–approval for planned admission?
  2. Data Entry: It’s important to identify your data entry points and to make sure that the trained staff performs the data entry on the appropriate software. If everyone is allowed to perform data entry, then what is your system to crosscheck the correctness of data entry?
  3. Expressive Communication: How does your team communicate with your end users? Do you have scheduled times to communicate new billing needs? How effective are your financial counseling sessions? Do you to do regular updates and do you communicate the changes to your patients?

Two other parameters to consider are feedback analysis and co-ordination while completing the entire billing cycle. It’s believed that man has the solution to all his problems, provided he looks within himself. The same is true for organizations, too. If practice/hospitals are to emerge victorious from this billing pit, then they have to strengthen, empower and encourage their team.

Despite of all the new software and procurements in medical billing and record keeping, billing is human centric. All administrators will agree with this fact,  there are several service delivery points in billing process and at each point it’s a human who makes an entry for the each and every service provided to the patient.

Part 2: The common myths practiced in the healthcare billing set-ups.

We have explained about the process for successful billing. There are few myths in billing which are dangerous and must be addressed if we want to have a successful plan of action for our medical billing.

  1. Billing is a discharge process: The fact is billing is an admission and pre-admission process which is only totaled at the time of discharge. The process of billing starts when the patient is at the admission department/receptionist. They should be addressed about insurance at this time and should be guided through the registration information.
  2. It’s the patient’s responsibility: The patient is only responsible to pay the amount. It is the medical facility’s role to let the patient know the amount to be paid, as well as to provide information to the patient regarding the insurance approval needs and the amount of co-payment.
  3. The patient is smart and well informed: People who have insurance are not always aware of a lot of things in their health policy. So it is the responsibility of the medical staff to ask and inform them about components like co-payments, excluded items cost, and out of pocket payments. It can be a routine job for the medical staff, but not so common to the patient. It is the responsibility of the staff to communicate and assist the patient so that they understand each and every query related to billing and payments.
  4. Brochures, websites and written material should suffice: Nothing can beat one-to-one communication between the patient and the staff. Speaking with patients over telephone or face-to-face will achieve the best feedback and allow a better chance for hassle-free payment from the patient. The mantra is “Expressive communication”.
  5. I’m just being professional: When you talk to the patient about the financial part of their visit, add that humane touch to it. Don’t just babble all the figures that you have scribbled, but explain in simple terms what each amount is for. That’s your job!
  6. Billing department is responsible for billing: This is a big myth which most medical staff believes. The billing staff only does the summation and segregation of the items under correct heading/sub-heading. Actual billing is done by the nurses or PAs. They are the people who add the components which are prescribed by the treating physician. So rather than blaming the billing staff for all errors, it’s better to understand that it’s the team effort which includes everyone to get an accurate final figure.
Part 3: The key areas to address in the billing process:
  1. Strong communication: Know who to address about the billing information pattern, who is the primary person responsible, what the best method of communication (in person, telephone, or email).
  2. Trained administrative staff: Administrative staff should have everything in writing and even the commonest information should be communicated to the patient.
  3. Prepare well before communicating: It is equally important to understand the medical facts about the patient before moving into a conversation regarding billing matters. The staff needs to modify the talks and may have to alter the time of discussion, if the patient is not comfortable or not in a condition where such aspects should be discussed.
  4. Team work for success: The administrative staff should be in touch with clinical departments, treating doctors, laboratory and radiology. This helps in understanding which patient requires new estimates and new insurance approvals.
  5. Double-check is important: A senior person should be appointed who can check the services given from the patient file to the amount billed, or not billed, for that service in the software for final accuracy.

It becomes easier to handle most billing situations, if these steps are followed. Many a time’s billing concerns can be avoided if administration handles the billing part smoothly.

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Shifting to a New Billing Practice

It’s not an easy decision shifting to a new billing practice. Billing metrics are complicated and transition can disrupt productivity and staff morale. But technology upgrades and output improvement are the necessities of a growing business. So, when you come to the big decision, it’s time to prepare for a smooth transition. By implementing some smart methods you can easily migrate to new improved billing practice without revealing to clients and vendors that you are upgrading to a new system.

In your medical billing practice, there may be 100+ non-collectable accounts receivable (A/R) and the decision with what to do with them is the real problem area. You can go ahead and hire a company that can help you completely clean those A/R out of your billing system, but this might delete some information that is important for claims.

The second option is to approach the new billing company to take things a bit further. Some may be willing to do a deeper outsourcing job, but be prepared that some billing companies might not be able to assist you. Higher fees will incur as there will be involvement of several additional resources from their end. The information they need from your practice will also increase to complete the claims successfully.

The third option is to courteously approach your most trusted and competent staff and request that they to assist during this new transition period. They know the business well and can prove to be a great asset. If they prove proficient in this new task, relief of their previous duties and promotion to this new position should be recognized, both in title and in salary.

When you change your billing practices you will need access to the database containing a record of patients in 100+ account receivables, filling in all insurance forms properly. To execute this work you will need the help of old billing company which generally doesn’t happen when you are switching to a new company. In that case, the new billing company might extend some help or you can still rely on old billing company if the trust is still there. This way most of the non-collectables can be collected, making it very cost effective. The trained staff can now handle the customer queries and the rest of practice can operate smoothly without any disruption. Your practice could pay a reward or offer an incentive for collections done each month to the staff involved in improving this process.

During the transition period, you can start planning the cash flow as the new system is being implemented by the billing company. You can also research an estimate of how many A/R were collected at your end. The team should be formed to ensure that gaps do not form in the new process and the documents are provided in a timely manner for claim submission.

When switching to new billing practice there are some other factors that need to be considered.

  • Before making the decision you need to properly analyze the new system as to whether it is efficient enough to handle your entire requirements. You should also have satisfactory IT infrastructure to execute the work without any productive time lost.
  • You should identify the difference between old system and a new system in terms of operation, learning and rectifying mistakes when they happen.
  • Another important thing is to choose a date when you usually have a lighter work load so you will not disrupt customer and employees functions.
  • Create SOP and other procedures to operate the new billing system in advance.
  • Staff and management both should learn the new system well and know how to handle any troubleshooting needed.
  • The new system should be tested and precautions should be made to keep the patient information safe.

Shifting to a new billing practice requires big decisions and preparations. Find comfort knowing the process will take some time but switching will bring efficiency and error-free billing to your practice, meaning a smoother and faster revenue flow.

By Nidhi Vats
Deputy Administrator
Shri Ram Singh Hospital & Heart Institute, India

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