revenue cycle management
Patient billing is an essential part of the Revenue Cycle Management (RCM) process. Healthcare RCM includes processes such as appointment scheduling and registration, charge capture, billing, possible denial management, and account receivable follow up. Without proper patient billing, providers will not be able to receive reimbursements in an efficient and accurate manner. This can lead to decreased revenue, increased stress, and wasted time spent on correcting claims.
How to improve patient billing?
There are many ways to improve the currently existing patient billing practices in your RCM, here are some suggestions:
Transparency in patient billing
Be upfront with patients about the costs of services before administering them and ensure that they understand them in detail. Additionally, invest in patient education tools (like brochures), which the patient can use to educate themselves about the billing process.
Provide the patients with simplified, but detailed, billing statements so that they can understand the costs.
Give patients the option to pay through a multitude of methods (online portals, installment plans, etc.) and communicate with them all the options that are available to them.
Improving patient payment collection
Patients are more likely to pay their medical bills on time when they have a clear understanding of their financial responsibilities. This is especially important for patients who may not be familiar with the complexities of healthcare costs, such as deductibles, coinsurance, and copayments.
Ensure that you receive accurate information from the patient regarding their health, contact, and insurance data. Utilize patient engagement tools, such as patient portals, to obtain the data before the patient appointment data; this would make the process easier and more convenient for both the patient and the administrative staff.
If financially viable, offer flexible payment plans for patients who might not be able to pay their fees upfront. It’s better to receive payments at a later date than to not receive them at all.
Most practices already offer multiple payment options, but this is still lacking in several rural areas; improving upon this practice could potentially lead to an increase in revenue.
Implement an organized follow-up process so that unpaid bills are collected and do not fall through the cracks.
Reducing billing errors in RCM
As we’ve stressed in previous articles and blogs, pre-authorization and insurance verification are a must before any services are rendered, as is following proper coding guidelines (if the provider has an in-house billing team, investing in ongoing training for the team is a must to ensure that they are up to date on guidelines and regulations).
Denial management can be a difficult and time-consuming process for administrative/in-house billing staff; the best way to avoid this would be to ensure that claims are filed without any coding or billing errors when they are submitted. However, this is also a time-consuming and often complicated process, so the provider should ensure that their staff is adequately trained and prepared to handle it.
Having an effective, efficient, and standardized automated protocol (which can vary depending on the needs and resource availability of the provider) for handling the process involved in billing (all the way from documentation through claim tracking and follow-ups) could lead to lowered risk of error and better consistency in billing.
Patient financing option in RCM
As mentioned above, offering multiple options for payment (online payment portals, payment plans, delayed payments) are all strategies that can be implemented by the provider to ensure that they receive full compensation from the patient.
Some other payment options that can be utilized to better serve patients is:
Financial assistance programs: Offering patients who might be income-shy due to extenuating circumstances discounted or fully covered treatment could lead to increased patient satisfaction, possible increased patient referrals, and depending on the patient’s insurance coverage, additional reimbursement from Medicaid/Medicare.
Pre-paid treatment plans: Often covered under the value-based care model, pre-paid treatment plans give the patient the option to pay their bills upfront before any treatment is rendered. This prevents the provider and their staff from having to concern themselves with worrying about payments and makes the billing process more convenient.
Automating the Patient Billing Process
Automation has become a part of our daily lives ever since the industrial revolution, and that is unlikely to change in the near future. It would behoove the provider and their staff to incorporate this practice into their billing protocol, as it could lead to fewer costs, quicker claim filing, decreased chances of denial, and it would be more efficient.
Role of Patient Billing in Value-Based Care
An often-repeated statement is that the customer is always right. In healthcare terms, we can adapt that to, “the patient’s needs must be met.” We, like many other organizations involved in the healthcare sphere, have talked about the importance of patient engagement and how significantly it impacts health outcomes.
The Impact of Patient Satisfaction on Billing
This is why it is of paramount importance that the patient is involved, properly educated, and understands their role in the billing process. Having that level of engagement would help the patient feel more satisfied and being more actively engaged in their own care, which would lead to them practicing proper self-care, incentivizing them to stick to treatment plans, and potentially reducing the risk of future negative health outcomes.
Trends in Self-Pay Patient Billing
A trend that is becoming increasingly popular due to a perceived lack of efficiency in the public healthcare system and an aversion to expensive insurance premiums is the adoption of self-pay. This is a method of payment where the patient pays out of pocket for their healthcare expenses. This is, in theory, preferable to the traditional patient billing methods, as it removes the complicated processes involved and reduces the parties involved down to just the patient and the provider (and their staff).
Providers who would be amenable to incorporating this method of patient billing can expand the pool of patients who might be willing or seeking to participate in this type of payment can increase their odds/facilitate this option easier for them by providing them with a multitude of payment options (such as flexible payment plans, upfront payments, discounts, etc).
Legal and Compliance Considerations in Patient Billing
We’ve already mentioned the key points to keep in mind to maintain a proper RCM cycle (proper documentation, correct coding practices, ensuring you meet guidelines and regulations, receiving informed consent) that meets legal requirements and compliance. It is also necessary to restate it to reiterate the importance of achieving and maintaining these qualifications, because a failure to do so would result in serious ramifications, ranging from fines to loss of license to practice, to even imprisonment.
As we said at the start of this blog, patient billing is a vital part of the Revenue Cycle Management process, much like one of the spokes in a wheel. If even one component of the RCM process is not operating efficiently, it can disrupt the entire cycle, leading to delays, lost revenue, and financial strain on your practice.
Don’t wait until the system breaks down. By proactively optimizing each aspect of your RCM-from patient registration and coding to claims management and billing-you can ensure a smoother, more efficient process that strengthens your practice’s financial health. Implement these strategies now to keep your revenue cycle running smoothly, ensuring long-term stability and success.
Let’s Talk About Enhancing Your Patient Billing Experience. Connect with our RCM experts for tailored win-win solutions for you and your patients.