Streamlining the Medical Billing Process: What Can Payers and Providers Do?

Everyone knows medical billing is a complex process, but with a few proactive strategies, both providers and payers can help make it run more efficiently.

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The medical billing process is a complex interaction of various parts and parties, and each phase relies on the others. From scheduling to reimbursement, a provider or healthcare facility’s revenue depends on the fair and prompt resolution of medical bills. But that doesn’t always happen. Often, the patient ends up being affected the most, but providers and payers can take steps to make billing more efficient for everyone involved.

Problems facing U.S. healthcare

Although Americans enjoy some of the best healthcare in the world, the system is one of the most expensive. According to a report by the Centers for Medicare and Medicaid Services (CMS), U.S. healthcare spending grew 4.6% in 2019, reaching $3.8 trillion or $11,582 per person. And the COVID-19 crisis only exacerbated rising healthcare costs when access to adequate healthcare services was needed most.

A primary reason for rising healthcare costs is the complexity of billing and reimbursement. Complicated processes increase the time between care provision, billing, and final payment or reimbursement. Incomplete or inaccurate information provided to patients also causes problems. Often, patients are not informed of treatment costs, care options, or payment alternatives. This drives up overall healthcare costs and may limit adequate access for uninsured patients.

How providers and healthcare administrators can streamline billing

The first step in the revenue cycle is patient scheduling. Make it simple and painless with a patient portal. When a patient registers for access to the portal, he or she provides background information, including demographics, medical history, current medications, and chronic conditions. They will also provide insurer information medical administrative personnel can use to verify the patient’s coverage before their appointment. With this information ahead of time, providers can better understand the patient’s history and work with payers to handle any prior authorization issues.

Providers can head off many billing issues by being transparent about the costs of treatment and available options. Also, be sure to use standardized forms. Providers and billing personnel can reduce claim denials by making sure documentation and coding are correct before submitting claims to payers. To enhance the ability to collect direct payments, make it easy for patients to make online payments and offer options for payments and payment plans.

How payers can help streamline the revenue cycle

Knowledge is key to billing and reimbursement efficiency. Payers need to thoroughly train staff about insurance coverage verification, patient eligibility, and prior authorization. They also need to educate providers and medical staff about the importance of proper documentation. Education and accuracy preclude problems of missing data, duplicate data, and typos.

The medical billing and reimbursement process is complex and confusing, and it’s not just patients who have difficulty understanding it. Providers, payers, and administrative personnel also find it difficult to navigate, but they can take measures to simplify and streamline it.

Use quality coders who are up to date with current codes and regulations. Use automation and medical billing software when possible. For maximum accuracy and efficiency, consider outsourcing revenue cycle management processes to a third-party medical billing company like TruBridge.

Written by Greg West TruBridge Director of Coding