New regulations and the changing healthcare scenario with its challenging mandates for providers and patients alike, is making the physician's life a bit tough. Billing in the medical industry today is a tough process that can bring in profit or cause loss, if not done right. Like it's said, a bad carpenter always blames his tools, so too, if the medical organization does not have the proper tools in place, the medical Revenue Cycle Management (RCM) will be affected. This is something nobody wants, given if there are hospitals and clinics going out of practice, then the Obamacare Act also known as the Accountable Care Act (ACA) will defeat its very purpose of bringing in the millions of medically uninsured patients and making healthcare affordable to them, and if there are no physicians to attend to them, healthcare will be in crisis.
Thankfully, technology has kept pace with changes in the healthcare reforms, thereby presenting a well thought out and systematic workflow for all types of healthcare clinics from- small to large, specialty to the integrated kind of organizations offering medical treatment. The tools required- all begin right from the reception room , as their part in the billing process is very essential- the appointment setter, insurance verifier, prescription safety, patient recorder, Practice management and Clinical documentation software, are the five most essential billing features and to have this all within one system will ease the billing process.
The Patient/Appointment Scheduler:
Without this software tool, you could overshoot the number of patients you see in a day and that could lead to problems, impacting the medical revenue cycle from the word go!
Insurance Verification Tool:
This is very essential before you even bill your patient. The patientbs insurance coverage plans are essential to know and should be verified as it allows for an increase in revenues and decreases A/R days by increasing collections of deductibles, copays and co-insurance ahead of the services being performed and thus decreases denials of claims after billing, thus minimizing the impact on your Revenue Cycle Management (RCM) process.
Prescription Safety Toolkit:
This is very rarely thought of as being part of the billing feature. But, the toolkit provides extensive detail on where and how to reconcile medications at all transition points of care and also how to implement a medication reconciliation process. An overworked staff could cause errors which could lead to a major incidence and could also lead to several blocks in the A/R process.
Electronic Health Records (EHR):
This is something that is now as important as the stethoscope seen around the neck of the attending physician. Not only should you now have an EHR integrated within your workflow, but it also needs to be a certified EHR, as it is essential to avoid the 1 percent Medicare Fee Schedule cut by the CMS, which could cause an impact in your RCM process. Additionally, many insurers are now insisting that they will deal only with digitized records and not paperwork, and payments will be made accordingly. EHR is beneficial to both physician as well as the healthcare industry, as it helps to track and monitor and also share information keeping the patientbs privacy intact.
Practice Management & Clinical documentation Software:
This is essential to have a smooth workflow process in your clinic or hospital. Given the increase in coding, and the focus on documentation required, especially when processing claims- having a robust PMS and CDS system in place will be advantageous to the practice. PMS tools can handle both billing and insurance claims and often have the added resource of scheduling and EHR management. But without testing and understanding your workflow, one can go in for either a single system or a multiplex of systems that integrate and is more suited to your practice and/or specialty.