Medical billing is complex and time-consuming. Does it have to be?
It’s a well-known fact that the U.S. healthcare system is the most expensive in the world. What may not commonly be as understood is that between 15 to 25 percent of total health care expenditures in the U.S. are attributable to administrative costs, and most of those costs are related to billing activities. With many steps to manage, including follow-ups on the payment side, practices need a better way to manage this process. This is where automation technology comes in.
Medical billing is complex and time-consuming, and involves multiple parties. The billing workflow begins from the moment the patient’s appointment is scheduled, through the registration process, to the patient’s one-to-one interactions with their healthcare provider. Once the provider encounter takes place, it’s up to the billing and coding staff to ensure the procedure, diagnosis, and prescriptions are accurately coded, which means correctly selecting from thousands of code options and accurately documenting the multiple codes that are typical of each patient encounter.
Receiving payment is another part of the process, and it can vary by office because in most cases, provider payment is shared by two parties – the patient and the insurer. While some offices collect the patient’s portion at the time of service, that practice is not always possible. Many offices first submit the claim to the patient’s insurer, then await a payment determination before billing the patient for their portion. Regardless of sequence, the fact remains that most often, two parties must be followed up for payment.
This part of the process can be lengthy. Depending on whether the insurance claim was sent electronically or by paper, whether the claim was “clean,” meaning it was accepted by the payer without requiring additional clarifications, and whether more detail was requested due to other factors, receiving a payment determination can take a while.
When the patient finally receives their bill, usually printed on paper and delivered via U.S. mail, a fair amount of time has likely passed since he or she received the medical service. Payment often requires some effort on the patient’s part such as calling the office to provide payment details, logging onto a website to enter account information, or making a payment by mail—all activities that are cumbersome. Paying quickly loses urgency after so much time has lagged between point of service and receipt of bill, so billing staff may find themselves following up by phone with a subset of patients for several months.
Aggravating the situation is that in recent years, the costs borne by patients are significantly increasing, with 30 percent of the average healthcare bill now being paid directly by patients, and 23 percent of families shouldering an annual deductible of $5,000 or more. The American Medical Association website notes, “As deductibles and coinsurance amounts continue to increase, so too has uncollected patient financial responsibility, resulting in physician practice bad debt spiraling out of control.”
On the other hand, a 2021 surveypublished by U.S. Bank highlighted that the demands that the Covid-19 pandemic have pushed consumers towards digital payments, but there’s a lot of room for improvement—only 28% of people pay their bills online which means the majority of patients are payment by phone, mail, or website. With consumers continuing to use inconvenient, manual methods for payments, the pandemic stretched the capacity of medical practice staff who would otherwise be dedicated to other important activities within a practice.
The U.S. Bank report also showed that “37% [of patients] would like to pay via portal, and 32% would like to pay via a mobile app. Nearly half wish their healthcare provider allowed them to pay via contactless credit or debit card....” Additionally, “Nearly half said healthcare was the most difficult industry to make a payment, although nearly 70% said they agree that healthcare is keeping pace with other industries when it comes to payment innovation and providing creative ways to pay bills.” Much of this innovation can be credited to the companies who pivoted quickly during the pandemic to change the way patients and providers operate billing and payment activities.
The pandemic has provided the healthcare industry the unique opportunity to revisit current workflows and procedures, and to embrace technology in a way that can help practices improve financial viability while making life more convenient for patients. This has already happened in a big way through telemedicine, which has experienced a 63-fold increase among Medicare patients over the course of the pandemic.
In a world in which we’ve moved much of our lives online or onto our mobile devices, whether it’s ordering food from an online grocer, or depositing a check using online banking, informing patients of healthcare costs prior to treatment, delivering digital bills that employ clear language to detail services rendered, and offering one-click payment options should be the norm.
At the same time, improving the revenue cycle can only benefit healthcare providers, particularly those small to mid-size independent practices for which cash flow management can have a real impact on operations. By reducing outstanding balances and back-end collection costs, cash flow will increase, and administrative burden will be reduced, improving the work atmosphere and enabling more time for patient interactions. A number of companies, including Tebra, are working on digital solutions to streamline practice workflows and put technology to work in a way that fulfills its promise.
I believe it is of utmost importance that we implement holistic systems developed from a fresh perspective of consumer and provider need, based on the way our world works now. Too many digital products introduced over the years have really only served as add-ons or replacements for legacy processes that evolved from a paper- and telephone-based environment.
A key factor to consider in implementing new billing and payment technology is whether that solution has all that the practice will need – not only in terms of being comprehensive, but also in terms of being customizable so that the technology adapts to the practice, rather than requiring the practice to adapt to the technology. It’s also important that any and all of the technologies a practice uses can function concurrently and seamlessly as a fully-integrated platform. Interoperability is the difference between streamlining a workflow or creating an administrative burden.
My company is working to rethink the provider-patient experience from a consumer-centric perspective, which starts with one platform, rather than relying on disparate, “plug and play” technologies. We see ways to initiate engagement before a patient even enters the care of the practice, and to leverage the technology at our fingertips to improve communication, reduce duplicative work,and improve the fee-paying process and time. We use data-based software automation to track at all touchpoints of the billing process, and at the same time, improve clinical practice. Instead of making the task of bill paying a frustrating process done by mail or phone, patients have the opportunity to view their bills from a mobile device and instantly make payments at their convenience.
The beauty of this—from a practice perspective—is that most of these processes can be automated, which requires minimal staff oversight and frees them to focus on other important tasks. Practice staff can allocate significantly fewer hours to billing, with the end result of achieving better revenue outcomes and patient experiences. At the same time, providers are freed to be more present during each patient interaction. Practices that have signed onto the full digital experience save, on average, time equivalent to that of two full-time employees through the automation of administrative tasks, which I’ve personally seen with our billing and provider clients.
The digital tools are in place, and we are using them in other areas of our lives. Let’s maximize their potential to make the healthcare experience efficient and effective, and make life less burdensome and more convenient for patients, medical staff, and the industry.
d’Artagnan Osborne is the General Manager of Payment Solutions at Tebra where he leads the payments business unit. Tebra was formed through the merger of Kareo and PatientPop in November 2021 to create an all-in-one practice success platform to build the independent practices of the future. d’Artagnan is a business and technology leader with over 20 years of experience building ahead-of-the-curve SaaS products from concept to commercialization. He has delivered cloud-based software solutions that help drive modernization of industries ranging from healthcare, fintech, and cloud security.
d’Artagnon joined Kareo in 2018 as Vice President of Engineering where he led the design and delivery of Kareo’s technology systems and offerings. He was promoted in 2021 to form and lead a new exciting business arm of Kareo, now Tebra, focused on solving the challenges today associated with healthcare payments.