Getting paid as an independent healthcare provider is harder than ever. Patients are paying more out of pocket and are more likely to change providers if they are unhappy. Payers under pay and deny claims every day. What's more, staff don't follow up on denials and rejections because they are simply overstretched.
It's easy to think that there is no solution to getting paid correctly. This is just the way it is in healthcare. But, the reality is that whether you manage your medical billing in house or outsource it, technology can play a critical role in reducing costs, increasing revenue and unburdening staff.
A big part of the problem is outdated software and ineffective processes. Many practices have a mix of paper, server-based and cloud-based solutions and often lack true financial policies or specific policies for processes like patient collections. A recent Black Book survey found that 72 percent of small practices attribute their financial troubles to their underperforming billing technology and compound payment issues. Another study found that about two-thirds of practices agree that their billing software and processes need upgrading.
Outdated technology could be holding your practice back in more ways than one. First, it may lack critical features like automated eligibility that can save time and money. Second, older systems may not integrate, requiring staff to enter data more than once into multiple systems and increasing workloads. Finally, despite all the added work, you may not be getting paid all that you are owed.
Where there's technology, there's a way
There are pros and cons to do-it-yourself billing and outsourcing your billing, and each practice should make that decision based on their unique needs. But one thing remains the same—technology can make or break the success of your revenue cycle. Does your current software allow you and/or your billing company to complete these tasks electronically?:
Enter patient demographics one time for all practice management, billing, clinical and practice marketing activities
Electronically verify batch or individual eligibility at any time
Complete an electronic superbill and then submit to the clearinghouse
Text and email patient communications like reminders, recalls and surveys
These are just some key examples of the kinds of things you should be able to simplify and automate today. And, each of these comes with real bottom line results.
Entering data once has obvious time savings, but consider what staff could do with that time. They can focus more on patient care and satisfaction. They can work on the practice’s online reputation and marketing. They can support new providers and services to grow the practice. The possibilities are virtually endless.
Other financial benefits are more direct. According to a ZirMed study, ineligible patient insurance coverage causes more than 75 percent of all claim rejections and denials by payers. And MGMA found that only 35 percent of practices follow up on denials—so many denials are eventually just written off. Two different studies have shown that using an electronic health record to code your visit electronically can increase revenue by over $30,000 a year per provider. And text and email reminders can cut no shows by 30 percent to 50 percent, resulting in as much as $25,000 in annual revenue. You can see how automating these tasks could quickly add up to a big revenue increases.
To maximize the benefits of automation, consider a fully integrated solution that provides practice management, billing, clinical and marketing or patient communication tools with one database and one login. Eliminating extra data entry is just one of the workflow benefits. You also get the benefits that come with a single vendor relationship. These include a single implementation, training program and support team. With one system to learn and use, staff can make the most of the training and what they learn applies to all the work they do, ultimately saving time and improving the staff experience. Plus, consider the impact having a single system would have on both recruiting and retaining providers and staff.
Big changes are coming to healthcare. Practices will need to meet MACRA requirements starting in 2017, there is an impending provider shortage, and patient due amounts just keep increasing. Now is the time to evaluate your technology and find the right solutions to tighten up your revenue cycle to ensure you stay independent whatever the future brings.