The Health Management Financial Management Association (HFMA) defines the medical billing service or revenue cycle as “all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue.” These include processes impacting healthcare organizations or medical practices, such as appointment scheduling, registration and verification of benefits (VOB), payment posting, collection from payers and patients, and anything else connected with accounts receivable (A/R).
Medical Billing or Revenue cycle management (RCM) has been a part of healthcare for years, with office staff traditionally handling billing, insurance verification, posting insurance payments and collecting any past-due remittances. However, it’s only been in recent years that many providers have discovered that their electronic health records (EHR) and practice management (PM) software may be capable of not only assigning codes and billing but performing some of the more mundane aspects of RCM as well.
More and more EHR and PM software vendors are adding revenue cycle management to their offering mix. Adding to the confusion is the fact that many companies that may have originally been billing services also re-sell specific kinds of EHR software.
Collections and Lost Revenue
To underscore the importance of merging billing service expertise with EHR in revenue enhancement, consider the recent studies showing that underpricing, wrong coding and other problems costs many practices’ between 25 to 30 percent of income that should have been reimbursed. One study reported in Becker’s Hospital Review cites that 40 percent of providers fail to collect from patients, to the tune of over $31, 713 per year. Additionally, a recent InstaMed study showed that 28 percent of providers have no idea exactly how much they write off annually.
In response to these issues, a growing number of vendors are integrating some form of in-office collections as well as code-checking and other factors. While these improved EHR features have a positive impact on RCM, some billing services that have developed good relationships between smaller providers have taken advantage of opportunities to become resellers of ambulatory versions of EHR systems.
Security and Certification – How Trustworthy is Your EHR?
One of the issues facing providers and other EHR users is the question of certification as well as security. HIPAA rules and the CMS have strict provisions in place that providers must adhere to or risk penalties. Providers billing Medicare must use EHR that is certified for the PI programs used as well as providing data security. (Note that EHR that was certified for other incentive programs or that was pre-owned is not eligible for certification for these programs.)
The CMS site offers information on their Certified Health IT Product List of EHR software vendors who have been banned, decertified or whose products needed corrections to make them acceptable. Knowing which system offers the required IT certification, capabilities and usability can help practices earn incentive payments while avoiding penalties and non-compliance headaches.
Advantages of Pairing a Medical Billing Service with EHR
With so many choices blurring the divisions between traditional billing services and EHR, some may ask why bother with a professional billing service on top of the EHR / VAR add-ons? One reason is that you can quickly see what your service is doing, as opposed to waiting days or even weeks to get a report from an outside firm. VAR companies, on the other hand, often have many other clients as well as dealing with everyday customer service issues, so your chances of having urgent questions and situations addressed promptly may be slim, costing additional time and aggravation.
Another reason for using a billing service is that EHRs don’t make phone calls, obtain supporting documents and arrange for payments. There are many aspects of billing and the rest of the revenue cycle that can only be done by trained, intelligent humans. Since most billing service employees are familiar with many kinds of software and systems, putting them in a position to be able to offer experienced, qualified advice to practices on their pain points, terminology and diagnostic codes.
In fact, many billing services, such as M-Scribe, offer numerous EHR-related client services, such as:
- Patient reminder calls
- Advanced eligibility verification
- Ongoing help with troubleshooting
Finding a Quality Medical Billing Service Company
As healthcare and the medical billing processes become more complicated, physicians need to spend time investigating a potential service’s transparency and history before committing their financial well being. Below are a few of the most important considerations, especially if you plan to use a service to assist in collections:
Cost: With most services charging as much as 4 – 9 percent of monthly billed revenue, you’ll need to compare quoted figures against the estimated costs of in-house billing and RCM. Ask whether there are clearinghouse fees and whether percentages include any co-pays collected by the practice’s own staff at time of services rendered.
Services: Most medical billing companies will examine claims for mistakes prior to processing as well as follow up with payers. Many now come with an EHR systems and AI capable of analyzing your ARs as well as recommending improvements. Get everything in writing.
Artificial intelligence (AI): Using smart rules-based AI can reduce denials as algorithms are continuously updated to stay current with payers’ differences by checking claims before filing.
Specialty-specific: Check into the service’s ability and experience in billing for your specialty, as the billing needs of an anesthesiologist will be very different from an oncologist’s.
Success rate: What is the company’s rate of successful reimbursement? Do they guarantee client satisfaction as well as fix any problems, such as rejections, that may arise?
M-Scribe partners with some of the best-known and respected EHR companies, utilizing cloud storage as well as AI for more secure yet rapid access to data between providers. With a 95.6% success rate thanks to technical staff able to work with a variety of EHR systems, as well as award-winning customer service, M-Scribe has been an industry leader since 2002. Contact them today for a free analysis of your practice’s RCM needs at 888-727-4234 or email to learn more about M-Scribe’s services.