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Learn MoreWhether it is a bill from a medical office practice, a freestanding surgery center, or a regular acute care hospital, there are some common medical billing issues that can impact revenue as well as patient perceptions of their experience. What are those issues and what is the best way to address them?
There are four issues that have consistently remained problematic in medical billing. They are:
1. Patient education -- Many of a patient’s medical expenses remain “invisible” to them. Healthcare pricing is typically a bit less than transparent, and patients (particularly those that are newly-insured) might assume that having insurance is all they need to completely cover costs associated with office and hospital visits. When Obamacare resulted in coverage for millions of people, many of them had high-deductible plans and did not understand that a significant medical event could leave them with up to $10,000 in medical bills for which they were responsible. A communication plan to help patients understand their financial responsibilities is an essential element in healthcare finance.
2. Coding errors – These mistakes remain a significant issue even as hospitals have become more experienced in applying ICD-10 codes. Incorrect coding of a medical service will usually result in a denial of a claim. Frequent communication between clinicians and billing staff, along with regular medical billing training and education to update staff on coding requirements, are essential to eliminating these errors.
Whether it is a bill from a medical office practice, a freestanding surgery center, or a regular acute care hospital, there are some common medical billing issues that can impact revenue as well as patient perceptions of their experience. What are those issues and what is the best way to address them?
3. Incomplete Patient Information– Failing to capture relevant patient information is still a very common barrier to full and timely reimbursement. Scheduling and registration staff are essential to this effort. Medical billing training and education to help staff understand the information that they need to collect along with the importance of this information is essential.
4. Manual Claims Processes – While many claims processes are now automated, there are still practices that rely on cumbersome and error-ridden manual processes and suffer the reimbursement consequences.
Even if our processes to educate patients and bill them correctly work well, medical debt remains a significant issue for consumers. In fact, it is medical debt and not poor or
irresponsible spending habits, which is the number one contributing factor in personal bankruptcies. So what is behind an increasing load of consumer medical debt?
A higher number of insured patients may not necessarily result in an improved accounts receivable sheet. Some patients may be unaware that their insurance plan requires them to be responsible for up to 20% of their medical expenses and carries a deductible of up to $10,000 in some cases.
Patients are delaying medical care. Financial concerns may play a part in a patient’s initial decision to delay medical care, but often does little to improve their financial situation as those delays can sometimes result in lengthier and costlier treatment. That more costly treatment can result in increasing medical debt for some consumers. Snowballing medical debt has far-reaching effects—bankruptcies and drained savings accounts can be the result of large or unexpected medical bills.
The Healthcare Financial Management Association’s (HFMA) Patient Friendly Billing Project has the tools to help healthcare organizations work with patients towards a less-punishing process. The initiative is based on HFMA’s research showing that patients want financial information that is clear, concise, correct, and patient-friendly.
In addition to establishing these parameters for patient financial communication, HFMA also has published best practices in patient financial communication with unique strategies to address financial communication for each healthcare setting. Medical billing training is essential for staff connecting with patients about financial matters.
Because deductibles are likely to remain relatively large and insurance and healthcare expenses will also remain significant line-items in many household budgets, it will be important to embrace best practices in patient financial communication to keep patients informed, comfortable with their understanding of their financial responsibilities and to protect revenue cycles. It is also important to provide staff with regular training to address the need for accurate coding and full and accurate patient billing information.
All staff with patient access must perform effectively to ensure the success of the revenue cycle in its entirety. With the shift toward high-deductible health plans and the growth in newly insured individuals, Patient Access is faced with communicating and collecting increasingly larger amounts for which patients are financially responsible. In addition to patient communications, these employees must fully understand insurance plans, coordination of benefits, medical necessity and ABNS, and the importance of the demographic and insurance information they collect and record. Learn about HealthStream solutions for training general Revenue Cycle and specific Patient Access staff.
HealthStream’s learning management system and healthcare training solutions support medical training initiatives and allow for the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsComprehensive, industry-leading provider onboarding and credentialing software that validates health outcomes and supports provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
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