Automating The Medical Billing System For Faster Reimbursements

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. Medical facilities cannot return money for the provided services in time, which may even result in bankruptcy.

Automated medical billing is a way to ensure timely reimbursements. Automated medical billing software implementation enables providers to automatically generate superbills and submit claims once a patient receives services. It considerably shortens the reimbursement cycle and reduces unpaid claims.

In this article, we share 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 you.

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 status of the claim 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 requirements discovery to find what approach to building an automated medical billing system is best in your case.

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 the 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. 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.

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.

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 showed that only 20% of consumers always know how much they will owe, while 87% were surprised by a medical bill last year. Unexpected payments result in frustration and unwillingness to use the healthcare provider's services again.

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.

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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.

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

Why medical billing is still not automated

Even though the healthcare industry is quick to adopt changes, it's quite rigid in billing. Recent research shows that 70% of patients still receive medical bills via mail. There are several reasons for it. First, the financial field keeps following traditions in many aspects, and paper bills seem more reliable (which is not true). Second, medical billing automation requires investment and, most importantly, tech expertise. Many healthcare providers still lack the resources to start this digital transformation.

Nevertheless, tangible financial benefits will likely speed up medical billing automation soon. Automated billing practices allow healthcare providers to achieve a net collection rate of 96% . Besides, younger generations pay attention to the convenience of payments choosing a provider. 74% of millennials would switch practices for a better healthcare payment experience. Such a market demand may nudge medical facilities to adopt automated billing solutions sooner than planned.

Automated medical billing software: ready-made and custom

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.

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 from $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.