5 Helpful Strategies to Improve Your Healthcare Billing Process

Healthcare providers are usually more passionate about improving and saving lives than managing the healthcare billing process. However, effective billing is essential for keeping offices, clinics and health systems up and running. As a result, providers need to prioritize timely and accurate billing.

A successful healthcare billing process begins with precise information, along with payment options patients can easily access. According to The Payment Cure: How Improving Billing Experiences Impacts Patient Loyalty, a joint report between PYMNTS and CareCredit, 65% of patients prefer to know the costs they will be responsible for paying prior to receiving care. Additionally, more than half (54%) seek out providers that offer payment plans or third-party financing options to cover care.¹

In this guide, you’ll learn strategies to help streamline workflow, ensure compliance, keep payments flowing and improve the patient experience.

How Healthcare Billing Works

First, let’s get down to the basics. Coding and billing are the processes of submitting patient data from treatment records, often called the superbill, to insurance companies or third parties for payment. The healthcare industry, government and patients depend on health systems and practices to record, register and keep track of each patient's account so they can accurately charge patients for the services they receive.

Billing or claims processing refers to a series of steps that document any billable activities along a patient’s journey, from registration through treatment and follow-up. Successful claims processing is a joint effort that can include the following team members:

• Scheduling team. When a patient calls your office for a new appointment, a scheduler gathers basic information to determine if insurance will cover the office visit.

• Registration team. Upon arrival, new and existing patients hand over their insurance cards and government IDs. Verifying patient insurance information at this point is critical to the claims process. Then, they fill out paperwork to update their demographic and other patient information. This process is critical since correct patient data can help prevent denied claims.² When the patient checks out, the front-office staff begins the revenue cycle by collecting copayments or other out-of-pocket costs.

• Providers. After the patient completes the initial paperwork, they have their office visit, procedure or test. During the appointment, the physician or healthcare provider documents all billable services using a superbill or digitally annotates the visit via an electronic health record (EHR).

• Coders. After the patient’s appointment, a medical coder receives the patient’s chart or EHR. Before claim submission can occur, coders must translate the provider's notes about services into billable codes using Current Procedural Terminology (CPT^®) codes. These codes vary based on the services provided and the level of care.

• Billers. Next, the coder sends the coded record to the biller, who manually enters the information into the claim form or uses billing software. When complete, the biller sends the claim to the payer or a clearinghouse for reimbursement.

Options to Improve Your Healthcare Billing Process

Following each step in processing healthcare claims and doing so precisely may ensure timely payments, improve patient experience and reduce the likelihood of healthcare fraud.³ Often, health systems and providers can improve the billing and collection process. Here are some ways you may be able to streamline and improve revenue cycle management:

1. Offer up-front billing consultations

Patients today may be more informed than ever before. With a shift to higher out-of-pocket expenses and a greater focus on healthcare cost transparency, patients often want to know early on what their financial responsibility will be.

Leverage best practices for communicating patient financial responsibility, such as the following:

• Before providing care, do your best to provide cost estimates and help clients understand what their out-of-pocket expenses will be.

• Use easy-to-understand language when explaining costs and patient responsibility and encourage questions.

• Inform patients early on about their payment options, including patient financing, if offered by your practice.

Informing patients about the cost of services before they receive treatment can build transparency and trust.

2. Streamline in-office communication

Traditionally, the superbill was the only communication among scheduling and registration, clinicians, coders and billers. A great tool for the provider for billing purposes, it also provided information about follow-up scheduling and patient billing data. In many offices, the electronic health record has replaced the superbill.

These records work well but can be challenging for billers to interpret. While it may be easier for providers to check boxes next to billable events, they could overlook the necessary details required to support the procedures. If the documentation doesn't match the charges or if any information is unclear, the biller may need to clarify the ambiguous language with the clinician.

You may be able to improve efficiency by making it easier for billers to fact-check codes. In small offices, the office manager may facilitate communication between clinicians and billers. Busier practices may favor text messaging or priority email to help billers quickly reach providers or their designated assistants.

3. Improve the claims submissions and denial management process

Some of the most common reasons insurers reject claims include:⁴

• Claims being filed outside the required deadline
• Claims for out-of-network services
• Claims for services that are not covered
• Lack of documentation showing medical necessity
• Lack of pre-authorization from the insurance carrier
• Missing or incomplete patient or provider information
• Use of incorrect codes

When you submit claims to the insurance company, you may need to verify the correct billing format, append the proper modifiers and submit all required documentation with each claim. In most offices, claims are submitted using billing software. Learning to properly use the software may be essential for successful billing and to prevent claims denials.

If everything goes smoothly, insurers pay claims without time-consuming follow-up. Here are a few strategies that may help improve those odds:

• Keep current on new codes. The job of a coder is to analyze data. Every procedure performed in a healthcare setting has a specific code assigned to it. Coding professionals need to code properly to ensure correct billing and maximum reimbursement for the physician or facility. To do so, staff must stay current on coding guidelines, including the ever-changing procedure codes as determined by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS).⁵

• Revise and resubmit claims quickly. Before denying a claim outright, the third-party payer or insurance company often gives the provider a chance to modify it. Consider developing a process for revising and resubmitting claims to help reduce costs and encourage faster payment.

4. Understand when to appeal

First of all, don’t be afraid to appeal. If something goes wrong during the process and the payer doesn't pay or sends the wrong amount, consider filing an appeal. You may improve your outcome on appeals with two basic strategies: keeping impeccable records and staying calm during negotiations. For best results, use the exact verbiage from your contract to formulate the appeal.

If a payer repeatedly pays late, consider appealing in violation of prompt pay. Prompt pay rules define the amount of time in which a payer must pay a claim after receipt.⁶ These statutes are different in each state, so look up the statute that applies to your business. If the payer doesn't pay within the specified time frame, the statute usually obligates additional interest payment, which accrues for each day the payment is overdue.

5. Prevent patient bills from going to collections

Hospitals of all types have provided close to $745 billion in uncompensated care to their patients since 2000.⁷ One way to prevent this bad debt is to consider these questions as you encourage patients to pay their bills before they go to collections:

• Is there a copay? If so, you may want to collect it before the patient leaves the office.

• Is there any unmet deductible? If so, notify the patient.

• Are you out of network? If so, what are the out-of-network benefits? Consider alerting patients to the additional costs of using an out-of-network provider.

• What is the coverage for the service? Is the visit a procedure for which a patient may need to pay a deductible or coinsurance obligation? If so, let the patient know as soon as possible so they can budget accordingly.

Also, consider these two strategies to help prevent the collection process:

Implement a patient billing portal

A billing portal — a hosted page where patients can manage their billing information integrated into an easy-to-navigate system — can be part of a larger patient engagement strategy. But despite the demand for online billing access, only 21% of patients at group practices and 25% of patients at private practices who were surveyed in a PYMNTS study paid medical bills on the provider’s website.⁸ Online payment portals are more likely to convert payments than paper billing because they meet patients online where they are.

To ensure success, work with an expert to design your portal from a patient’s perspective, and remember that an effective billing and collection strategy prioritizes the needs of the patient over the biller. For starters, cost transparency goes a long way. As highlighted earlier, patients overwhelmingly value up-front cost information, yet only 30% currently have access to it before treatment, according to The Payment Cure: How Improving Billing Experiences Impacts Patient Loyalty.¹

Offer more ways to pay

Over the last decade, healthcare has moved from a strict fee-for-service model to offering bundled services and value-based care. This shift toward patient-centric models reflects the desire of today’s healthcare consumers to take charge of their health.

Due to high-deductible healthcare plans, some patients may avoid insurance companies altogether, preferring to pay for services, tests and procedures on their terms.

Moreover, some health systems and practices may work with patient financing companies to offer their patients flexible ways to pay. When patients use the CareCredit credit card as a payment option, for example, immediate benefits include:

• Providers get paid within two business days with no recourse if a patient defaults.*

• Cardholders can move forward with the care they want and need.**

• Health systems and health and wellness practices may be able to improve the flow of payments and reduce accounts receivable.

Trust the Process and the Pros

Billing and collections are a vital part of healthcare. Hospitals, doctors and clinics depend on the process to get paid, keep track of a patient's medical experience and keep practices running smoothly. Help empower billing staff by implementing the above strategies, which may improve your billing process while assisting patients to get the care and treatment they need.

A Patient Financing Solution for Health and Wellness Providers

If you are looking for a way to connect your patients with flexible financing that empowers them to pay for the care they want and need, consider offering CareCredit as a financing solution. CareCredit allows cardholders to pay for out-of-pocket health and wellness expenses over time while helping enhance the payments process for your practice or business.

When you accept CareCredit, patients can see if they prequalify with no impact to their score, and those who apply, if approved, can take advantage of special financing on qualifying purchases.** Additionally, your practice or business will be paid directly within two business days.

Learn more about the CareCredit credit card as a patient financing solution or start the provider enrollment process by filling out this form.

Author Bios

Pamela Cagle, R.N., has extensive experience in a range of clinical settings, including ER, surgical and cardiovascular. For the past decade, she has leveraged her nursing experience in writing for health and technology publications such as AARP, VKTR, National Council on Aging and others. She is passionate about blending her medical and storytelling expertise to bring authenticity to health and wellness topics.

Diane Faulkner is a freelance writer, speaker and human resource consultant with more than 30 years of experience in B2B content for HR, technology, health/wellness and finance. Before her writing career, Diane was a vice president of human resources for a major credit union. She is a certified senior professional in human resources (SPHR).

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