How Automated Medical Billing Transforms Healthcare

Automated medical billing is a way to ensure timely reimbursements.

The problem is payment delays caused by medical bill errors, missing insurance coverage, or bureaucracy create a tremendous load on healthcare providers. In 2019, the total medical debt in the US equaled $195 billion and kept growing (Source ). Medical facilities cannot return money for the provided services in time, which may result in bankruptcy.

Automated medical billing software implementation offers a solution, enabling providers to automatically generate superbills and submit claims once a patient receives services. It considerably shortens the reimbursement cycle and reduces unpaid claims.

This article shares how to automate medical bill payments to optimize billing. Binariks has experience with custom healthcare software development , including medical billing automation. We can create an automated billing system or integrate an existing solution for your needs.

Medical billing process overview

Medical billing is a detailed process that involves translating patient services into claims for insurance reimbursement. It’s not just about submitting claims—it requires precise coding, compliance with insurance policies, and managing rejections or delays. Even small mistakes, like a coding error or missed deadline, can slow down payments and create unnecessary hassle for the billing team.

The regular process of claims and billing automation is quite lengthy and complicated—to get paid for services, a clinic must collect patient demographics, verify insurance eligibility, assign diagnosis and treatment codes, prepare an itemized super bill, and submit claims to the payer. After the claim adjudication process, they track insurance payments, settle any co-pays or deductibles, and bill the patient for any remaining balance.

Automation simplifies the process by handling tasks such as verifying claim accuracy, checking for coding mistakes, and tracking claim status. Thus, healthcare providers can avoid common errors, speed up payments, and reduce staff stress. This leads to smoother operations and better financial outcomes for the practice.

Benefits of automated billing system in healthcare

Automation in healthcare is incomplete without automated billing. Thus, every medical provider undergoing a digital transformation must adopt robotic process automation (RPA) for billing. Apart from being a pure necessity, automated claims processes give medical providers many practical benefits.

Increased revenue

Because of poor billing practices, US doctors lose an estimated $125 billion annually (Source ). The financial losses usually happen due to denied claims, services not covered by the payer, or the inability of patients to pay their part—about 12 million Americans $2.000 in medical debt (Source ).

Practices that integrate an automated healthcare billing system can considerably increase approved claims and double-check a patient's eligibility for insurance beforehand. This way, they can reimburse the provided services faster and grow revenue.

With Robotic Process Automation (RPA), repetitive tasks like claim submissions and insurance eligibility checks are automated, reducing errors and denied claims. This leads to faster payments and higher approval rates, helping healthcare providers recover revenue more efficiently. RPA, a technology that uses software bots to mimic human actions, handles routine tasks, freeing staff to focus on more critical work.

Enhanced productivity across teams

Automation eliminates many manual processes or makes them considerably faster. Thanks to this, medical staff can handle more claims with higher accuracy. Physicians also win from billing automation as they have reliable data on what healthcare services are reimbursed. These details allow them to make treatment decisions that benefit patients the most.

Fewer mistakes in documents

When software generates claims and bills, the likelihood of mistakes is very low. It retrieves the necessary data from the database, medical documents, and forms to render the required PDF. All details are verified and standardized to avoid errors before ending up in the final document.

Shorter payment cycle

Automation allows healthcare providers to get paid much sooner. While obsolete invoicing approaches can stretch the cycle to four weeks, automation shortens it to several days. As a result, the company's finance management considerably improves as it receives steady recurring payments fast.

Transparent reporting and compliance

Medical billing is strictly regulated. That's why providers must keep detailed reporting on reimbursements. Since paper document management is cumbersome, using software is an optimum choice. Automated software makes every operation related to billing trackable and helps stay regulatory compliant.

More satisfied patients

InstaMed's 12th annual report highlighted a critical issue in the healthcare industry: only 20% of consumers always know how much they will owe, while a staggering 87% were surprised by a medical bill last year. These unexpected payments result in frustration and unwillingness to use the healthcare provider's services again (Source ).

Automated medical billing makes healthcare payments more predictable due to eligibility checks. Patients can learn expected expenses to be better prepared for them. Such awareness increases patients' satisfaction. Besides, the reduced risk of claim denial additionally benefits patients' experience.

What can be automated in medical billing

We know that implementing automated medical billing seems complicated. But, in reality, billing consists of many repetitive tasks you can delegate to software instead of doing them manually. Here are the main processes to consider when automating medical billing:

• Data exchange and extraction: Automated EHR data migration , exchange, and retrieval are a part of electronic health records and billing automation. It allows you to build an EHR system that frees medical staff from manual data entering as all information is pre-filled and delivered for them.
• Report and bill generation: Make the medical payment system independently render reports, bills, superbills, invoices, and other financial documents. It will ensure higher accuracy and reduce manual chores.
• Claim processing and tracking: Automatically update fee schedules, track claims, and post payments to ensure every claim is paid on time. It will minimize the risk of underpayments and protect healthcare facilities from financial losses.
• Patient and insurance plan checks: Free staff from the need to manually contact an insurance company to inquire about the patient's plan. Instead, develop software capabilities to run electronic verification and generate a response with insurance details.
• HIPAA reporting: Automatically record and store data to ensure the personal health information security required by HIPAA. You may also generate automated reports to simplify self-audits for HIPAA compliance.
• Revenue cycle management: Track claim approval and payment updates all the way from patient registration to the final payment for healthcare services received. With RPA capabilities, you can even automate pre-authorization using unattended bots.
• Patient registration: Automating patient registration frees staff from manually entering demographic and insurance details. Instead, the software gathers this information from patient forms, verifies it, and uploads it to the system, making the intake process more efficient and error-free.
• Superbill creation: Automation handles the creation of superbills by extracting the necessary codes from patient records. This minimizes manual errors and ensures that all relevant services are properly documented for billing.
• Claims generation and submission: With automation, claims are generated from patient data and submitted electronically to insurers. This process reduces the risk of claim rejections and accelerates payments.
• Adding relevant ICD codes: Automated billing systems assign ICD codes to each patient case based on diagnosis and services rendered. This reduces coding errors and ensures faster claims processing.
• Payment accessibility: Patients can access multiple payment options, including online portals and installment plans, through automated billing systems, streamlining collections for healthcare providers.
• Patient eligibility check: Instead of calling insurance companies, automated systems verify patient insurance details electronically, ensuring that the necessary coverage is confirmed upfront.
• Monitoring claim adjudication: Automation tracks the entire claim process, from submission to adjudication, ensuring that claims are approved and paid promptly.
• Patient statement preparation and follow-ups: Automatically generate patient statements and send payment reminders to reduce administrative tasks and ensure timely payments.
• Providers license & NPI data verification: Automation verifies provider licenses and NPI numbers before claims are submitted, reducing rejections due to incorrect or missing information.
• Denial management: Automated systems track and analyze denied claims, identifying reasons for denial and allowing for quicker resubmissions and revenue recovery.
• Notifications and messages: Send trigger-based alerts and messages when something critical happens with a claim, information is missing, or staff needs immediate action. It will streamline communication between multiple teams participating in billing.

Read also: How to Implement Procure-to-Pay Automation

How to automate the medical billing process?

To automate the medical billing process, you can connect a ready-made healthcare billing system or create tailored features for your EHR. Just make sure the functionality covers the following medical billing stages to achieve full automation.

1. Speed up registration

Help patients enter their details faster and avoid mistakes through automated data verification during registration. They will instantly see the fields with the wrong format or missing info to fix them. It will save you from incorrect billing data.

For existing patients, you can automate healthcare payments through pre-filled data. The system must retrieve information from electronic health records to fill in the information required for billing.

2. Set up automated eligibility checks

Make your platform automatically check patient insurance eligibility to increase collections and avoid uncollectible revenue. You can verify insurance during patient registration or appointment scheduling to ensure it covers the provided services.

Eligibility checks usually happen through electronic verification. The staff sends a request, and the system returns an immediate response with the patient's insurance policy, copay terms, coinsurance, and deductible.

Read also: EMR appointment scheduling.

3. Automate coding and charge capture

After verifying the patient for appointment booking, you can automatically capture charges, collect the copayment, and render the medical report. Then, the system must forward the report to the medical coder, who generates a superbill.

At this point, you can facilitate the coding process by streamlining redundant data entry. Automation in medical billing allows coders to verify codes against payer reimbursement rules quickly.

4. Implement billing compliance checks

Forward the generated superbill to a medical biller. Apart from streamlined billing, the automation of medical billing checks also ensures compliance with OIG and HIPAA coding guidelines. If the format is incorrect, you will instantly know it.

5. Leverage electronic claims submission

Integrate an electronic claim submission process to forward requests to insurers automatically. You need it to build automated medical billing and stay regulatory compliant. HIPAA (The Health Insurance Portability and Accountability Act) mandates all health entities to submit claims through electronic data exchange.

6. Automate medical billing follow-up

Let your staff track the claim status within the billing platform to see whether it's denied, rejected, or accepted. More control over the billing process ensures that the provider is adequately reimbursed for the services and receives the deserved payment in time.

These stages reflect a standard billing process generally accepted in US healthcare. You may decide to automate only a part of operations or, vice versa, optimize some other functions. Ask Binariks to assist you with the discovery of requirements to find what approach to building an automated medical billing system is best for you.

Automated medical billing solution examples

Several advanced solutions in the market leverage automation and RPA to streamline the medical billing process. Here are some notable examples:

Kareo

Kareo is a cloud-based clinical platform that offers a comprehensive medical billing solution that automates billing workflows, claim management, and revenue cycle processes. It integrates with electronic health records (EHR). The platform deals with all revenue cycle management tasks at all steps. Key characteristics include billing analytics, automated ERA, unapplied payments processing, and claims submission.

NextGen

NextGen provides an automated billing system with integrated practice management tools, real-time claim tracking, and analytics. Some notable features include A/R reporting and templates for different types of bills.

Amazon Comprehend Medical

Amazon Comprehend Medical uses natural language processing (NLP) and machine learning to extract relevant information from unstructured medical data, such as patient records and clinical notes. This automation enhances the accuracy of coding and billing, enabling faster processing and reducing the likelihood of errors in medical claims.

AdvancedMD

AdvancedMD offers an automated billing solution that focuses on simplifying the billing process for medical practices. It includes features like automated claim scrubbing, electronic remittance advice (ERA), and customizable billing rules, helping practices maximize revenue and minimize denials.

Athenahealth

Athenahealth’s billing solution combines automation with expert support to manage billing and collections efficiently. It automates the claim submission process, tracks denials, and provides actionable insights to improve overall billing performance.

Ready-made vs. custom automated billing solutions

If you need an automated billing system, you will either integrate an off-the-shelf solution or develop a custom system for your organization.

Off-the-shelf solutions

Ready-made billing functionality is available as a part of EHR systems (NueMD, TherapyNotes, Praxis) or specialized billing services like Kareo. In this case, you integrate a whole pack of features and pay a monthly or annual fee to access them. It may be an effective option for independent practices that only start working.

Custom billing solution

Custom billing features are practical for medium and large software providers. On-demand development ensures you automate every necessary process while staying independent from third-party software vendors. You also don't have to pay monthly charges and wait for updates.

Biggest challenges in medical billing automation

Despite rapid changes in healthcare, 70% of patients still receive medical bills via mail (Source ). This persistence stems from the traditional preference for paper bills, perceived as more reliable, and the investment and tech expertise required for automation.

However, with automated billing leading to a 96% net collection rate and 74% of millennials willing to switch providers for better payment options, financial benefits, and market demand, healthcare facilities are likely to push toward automation sooner (Source ).

Here are some of the biggest challenges encountered in the quest to automate healthcare payments:

• Dealing with legacy software that cannot be easily integrated via API
• Ensuring that payments are not late
• Coding errors that may lead to claim denial
• Non-compliance with HIPAA and other standards

How much does it cost to automate medical billing?

To connect a third-party billing service, be ready for two core expenses. You must hire software engineers to complete the integration and pay a monthly fee to the software provider for the rest of your life. Charges vary depending on the system you choose. For example, eClinicalWorks charges 2.9% of practice collections.

If you want to develop a custom automated billing service, the cost largely depends on the functionality. A basic solution will cost around $80.000 — $120.000. A system with AI/ML capabilities may require a $150.000 investment and up.

Summary

Binariks is a healthcare software development expert that can assist you with medical billing integration and development. We evaluate the needs of your organization to recommend the most effective solution in your case.

Binariks can:

• Consult you on the best way to automate medical billing within your company
• Connect an off-the-shelf billing solution to your existing system
• Provide our software engineers to strengthen your in-house team working on a medical billing solution
• Assemble a dedicated software development team, including a PM, business analysts, designers, software engineers, and QA specialists, to develop tailored billing solutions for you.

We have already completed several projects involving EHR and billing integration and know how to do it. Check our portfolio to learn more about how we work.