We’ve reached the technological plateau where technology has become so advanced that you can get tools to make virtually any process more efficient or profitable. In a healthcare setup, gone are the days when doctors and hospital staff would note everything down on a piece of paper.
Now, you can use CRM software, automation tools, EHR systems, and medical billing software to take the administrative workload off your plate. And this is no secret. In fact, this is where most of healthcare spending in the US is focused nowadays.
According to a survey by Bain & Company and KLAS Research in June 2023, 75% of respondents from the healthcare industry expected the healthcare software spending to rise in the following year.
Even though most hospitals in the US have EHR systems in practice, there’s still a lot of avoidable paperwork especially when it comes to revenue cycle management and medical billing. Come let’s find out why more healthcare organizations should look into automating this segment, and how it can drive revenue growth.
Medical Billing Software Streamlines Billing Processes
When a patient makes an appointment using a hospital’s appointment scheduler, and visits a clinic or hospital, they’re asked for information like medical history, allergies, previous medication history, and insurance details. The hospital uses the insurance details to verify a patient’s eligibility for the procedures or treatment administered.
Insurance Coverage
Naturally, not everything is covered under insurance. And the initial eligibility check ensures that both the patient and the healthcare provider are clear on the division of expenses because of deductibles and insurance type.
Revenue Cycle
After the treatment is done, the provider has to file a medical claim to the insurance company to get paid for the services rendered. If they don’t use a software, they have to make sure that they enter correct information and assign the right medical codes.
If any of this information is incorrect, the insurance payer will simply reject or deny the claim depending on the discrepancy. This means the provider won’t get paid for their services. Then, they have to make the necessary corrections and file the claim again. This back and forth severely impacts the financial stability of a practice.
Automated Tasks
Hospitals and practices need a stable stream of revenue to keep things running smoothly. And this is where automation tools come in. A capable medical billing software comes in. It automates repetitive tasks like data entry, coding, and claim submission, which significantly increases the efficiency.
Improving Claim Accuracy and Reducing Denials
According to a survey, insurance companies deny one in five claims on average. Medical claims get denied for all sorts of reasons but incorrect or missing patient information or incorrect coding are some of the top reasons for denied claims.
Clearing houses and medical billers make sure that all claims comply with healthcare regulations including ICD-10, CPT, or HCPCS. This protects both the patient and the healthcare provider.
Automated Checks
A medical billing software can detect common errors with the help of automated checks before you go ahead and submit that claim. These checks can identify issues including incorrect codes, missing information, and inconsistencies, so you can make necessary corrections.
Enhancing Revenue Cycle Management
Revenue is just one part of the overall effort that goes into a patient’s care. A small practice could be using a home-grown EHR software, an EMR, or a CRM software for some or all of their processes. And that’s why integrating revenue component into an existing EHR/EMR system would make more sense to some.
Integration with EHR Software
For this, companies like CureMD offer customized billing software that you can easily integrate with your in-house EHR/EMR system. This reduces the administrative burden on your plate so you can focus on administering care and saving lives.
You can also get custom EHR software with integrated billing component if you don’t already have one. This integration reduces the need for manual data entry, minimizes errors, and results in quicker payment resolution.
Real-Time Tracking of Claims and Payments
The software allows healthcare providers to monitor the status of their claims and track payments in real time. This can help you identify bottlenecks, address issues promptly, and ensures that claims are processed quickly.
Managing Accounts Receivable
Think of accounts receivable as the money you’re waiting to collect. Efficient management here means sending timely reminders and automating follow-ups, so you get paid faster. Keeping on top of this ensures your practice stays financially healthy and growing.
Data Analytics and Financial Insights
A Medical billing software for let’s say Neurology billing is capable of generating detailed financial reports that include all key financial metrics like claim statuses, payment histories, and outstanding balances. With that data, you can also analyze patterns to discover new revenue streams. For example, you may notice a service or segment that’s underutilized or undercharged, to increase revenue.
Case Studies and Real-World Examples
Even though 96% of hospitals in the US use an EHR systems, the claim denial rate is on the rise, and not all of those EHR systems have integrated components to make the whole patient experience a lot more efficient.
Here are some real-world examples of successful integration of automated billing software into healthcare setups of varying sizes.
12% increase in Cash Collection (H3)
According to a case study published by the Quadax, the Samaritan Medical Center (Watertown, New York) was facing challenges in their revenue cycle billing operations. They didn’t have a clearinghouse, and had to resort to sending claims through different methods. And if a claim got rejected, this would add to their administrative pile.
After getting the claims management software, the hospital saw a 12% boost in their cash collection along with a 12% reduction in accounts receivables. This adoption also increased their reimbursement and saved staff time so they would spend less time chasing payments.
Revenue Increase to 22-26% Patient Collection
According to another case study by PMMC, a medical center in central Tennessee was facing issues with their underpayments where the insurance companies weren’t paying the full amounts they were supposed to. They recognized areas where they could be more effective at collecting payments from patients at the time of service.
After implementing the billing and contract management system, the hospital was able to calculate expected underpayments to recover lost revenue. From that, they were able to generate patient estimates which allows them to track payer performance and recover underpayments. And their patient collection rose to 22-26% from 5%.
15% Increase in Revenue for a Cardiology Clinic
In a similar case study by CureMD, a radiology lab in California was facing challenges in billing for their complex radiology procedures. Incorrect codes would lead to them not getting paid for those procedures, which was affecting the financial cycle.
After integrating CureMD’s radiology medical billing into their system, the clinic was able to reduce billing errors by 90% resulting in a 15% increase in revenue growth within a year.
Conclusion
That’s a wrap on medical billing software. Integrating medical billing services into your existing health record system can reduce administrative burden and also streamline your process. You don’t have to chase payments or argue with insurance companies all day to get paid for your hard work.
Medical billing software come in many forms and the right one for you depends on your practice’s specific needs. Most medical billing companies offer free demos, so be sure to check that out before singing up. The right software can process claims quicker, reduce denials, and effectively manage the revenue cycle management.
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