A clinic’s cash flow (and at times, survival), depends on the speed of claim transmission and payment posting. The right software can make all the difference in the world.
An integrated EHR and billing software system allows simple, one-click transmission of claim information from the EHR to the billing software, in addition to an array of automatic abilities to scrub claims.
The current healthcare environment is changing quickly. A gradual reduction in payments, increasing competition and a shift towards outcome-based payments have left physicians scrambling for ways to deal with decreasing revenue.
This is exactly where the right billing software can make all the difference. Clinics must find ways to streamline their billing processes for faster returns on the services they provide. The goal is to get paid faster. This has significant implications to cash flow.
The billing process begins when the clinician generates a claim. It has to be reviewed by the biller, scrubbed by the biller software and then sent to the payer. Since this is a multi-step process, there are multiple ways in which an integrated billing software can improve efficiency at all stages of the revenue cycle. Here are ten ways in which the right billing software can reduce denials.
1. Instant online eligibility verification to start with the right foundation
Ensuring that the patient has active, current insurance coverage is important. The front desk should be able to verify eligibility immediately online. The right billing software can capture a wide variety of data about the patient directly from the insurance company. The information can be used to pre-populate a patient record with no need to manually enter the data. This eliminates problems that can arise from misspellings or numerical mistakes.
- Seamless claim transmission from EHR to billing software to speed up claim submission
With one-click finalization of a clinical document, an integrated EHR allows practitioners to close a claim. The system then transmits the claim directly to the billing software by the time the patient leaves the office. The ability to schedule batch submissions speeds claims submission even further.
Submitting an electronic claim can significantly reduce the time for reimbursements to be deposited in the clinic’s account. The difference in turnaround time can range from 7-15 days, depending upon the payer or insurance company. Submitting a claim electronically is also less expensive. The average cost of a paper claim is about $6.60, while a claim submitted electronically costs approximately $2.90.
- Significant denial reduction to reduce waste
A billing software should scrub claims for any potential problems that might result in a denial. It should also notify billers about discrepancies with the use of modifiers, G-codes, ICD and CPT codes, and detect incomplete information. The ability to submit clean claims free of errors significantly reduces the number of denials and delayed payments. The right billing software will result in a significant reduction in medical errors, more accurate reimbursement, and improved documentation for highly compensated codes.
- Real-time tracking to monitor progress and adapt to problems
The journey of a claim, as it makes its way through the reimbursement process, can be rather convoluted. The claim has the potential to get hung up at any point. The ability to track and monitor each claim in real-time is an essential tool for improving billing efficiency. It tells the biller if a problem has occurred, what the difficulty is, and aids in maintaining closer control over how quickly claims are paid.
It also provides a window into any processes or time problems that may be resulting in slower claim reimbursements. An added benefit is that it allows billers to more closely monitor accounts receivable and take appropriate action to collect overdue balances.
- Automatic data transfer to save time and money
The ability to automatically transfer a mountain of data directly into the billing software can dramatically reduce errors. One of the ways in which billing efficiency in clinics can be enhanced is with electronic remittance advice (ERA). Unfortunately for clinicians, up to 30 percent of EMR software on the market doesn’t have the ability to deliver ERAs, forcing practitioners to deal with paper documents.
The automation of ERA posting, without the need to enter ERA data manually, saves several hours. When an ERA comes in, the billing software should be able to auto-post ERA information (and make changes if needed), allowing the billing process to be completed quicker.
Billers can also provide patients with an accurate bill or statement for their portion of the payment in a much shorter timeframe. This also facilitates quicker billing of secondary insurance (when applicable).
- Safety and peace of mind for clinicians and billers
A billing software can minimize the probability of an audit and help clinics deal with an audit, should it occur. All relevant documents are maintained digitally. Quick access to all records and claim information allows immediate retrieval of all pertinent information requested during an audit.
- Online payments to facilitate patient payments
Collecting patient deductibles is an ongoing problem for practices as individuals are being asked to cover an increasing dollar amount for their healthcare. For billing to be truly efficient, clinicians need to make paying easy by offering patients multiple payment options that can be immediately posted to their account.
An integrated billing software, which accepts online payments via credit/debit card and other payment methods is critical. Checks, cash, money orders and ways to make one-time and ongoing payments via bank accounts are conveniences that patients appreciate.
Part of billing includes collecting patient co-pays, a process that still continues to confuse patients. The front desk should be able to collect patient co-pays at the time of check-in and immediately post them to patient accounts, while generating invoices for patients.
- Patient-specific notes and alerts to streamline communication between staff members and patients
An unenviable but necessary element of billing is collecting balances from patients. Communication options in an EHR and integrated billing software should send patient appointment reminders, allow notes and alerts to remind the front desk to collect balances.
The ability for clinicians and billers to communicate with patients to deliver messages about any outstanding balance is an important part of billing software. Messages can be sent to the patient via the patient portal, allowing immediate communication in a HIPAA compliant manner.
- Detailed analytics and reporting
A billing software should make sophisticated financial metrics easy to understand. Being able to identify, and respond to important data points is an unprecedented advantage for your practice.
You should be able to get an incredible amount of insight with vivid pie charts and graphs, color-coded and drilled down by the patient, provider, payer, ICD-codes, CPT codes. You should be able to view instructive visualizations – charts and graphs, customizable and displayed in Excel format, track AR, revenue, payer performance and more.
A billing software should also help you set report templates and either run a report real-time or create a customized reporting schedule. With scheduled reporting, you should get the most important reports at regular intervals.
The right billing software allows clinicians to do what they do best – treat patients. Treating patients is the number one priority for all clinicians. Clinicians would rather spend time with patients, as opposed to typing into a computer screen.
An EHR and billing software that can save time results in an enhanced level of patient care and peace of mind for clinicians. This can shorten the revenue cycle in a healthcare environment that has radically changed since the implementation of the Affordable Healthcare Act. Much of the heavy lifting associated with revenue falls to billers, and an integrated, fully-featured EHR and billing software provides an electronic pathway to greater profitability that engages both practitioners and billers.
About the Author
Nitin Chhoda PT, DPT is a physical therapist, author and speaker. He is the founder of In Touch EMR, a leading physical therapy billing software, and In Touch Billing, a leading medical billing service.