Healthcare executives face a challenging task in balancing profitability, employee efficiency, and cost control, especially with the complexities of insurance policies and ever-evolving regulatory requirements. To minimize losses and optimize healthcare profits, executives must acknowledge the crucial role of an efficient medical billing process, which can be enhanced through innovative strategies and technology.
Insurance is one of the most important commercial aspects of medical billing, as the proper coverage check can mean the difference between a smooth revenue cycle receipts and a costly financial headache.
Challenges of Working with Health Insurance Companies
Working with insurance can be a significant challenge for medical facilities, especially for the billing team. These challenges are diverse and can impact the healthcare revenue cycle.
- Difficulty of staying up to date – policies and regulations change frequently (including Medicare and Medicaid insurance coverage changes during inpatient stay), making the latest updates difficult to keep up with. This can result in improper billing practices and errors due to outdated information, leading to claim denials.
- Increased administrative burden – working with patients’ policies is resource-intensive and may require a lot of manual work, making claim management with insurance a time-consuming and expensive task for the facility.
- Communication with insurance – there may be a lack of clarity on coverage details, payment rates, or preauthorization requirements, leading to delays and misunderstandings. Additionally, the billing staff may need to navigate through numerous phone calls, emails, and other correspondence to obtain the necessary information or resolve claim issues, adding further strain to the workload.
Coverage changes and the necessity of staying up to date is arguably the most important issue, as the failure to spot updates in policies in time directly impacts the facility’s cash flow due to incorrect claims, resulting in the loss of billing revenue.
Insurance Coverage Tracking
Effective patient billing requires a clear understanding of the patient’s insurance coverage and a streamlined tracking process. This involves close monitoring of the latest updates in patients’ policies (terms and conditions, coverage limits, out-of-pocket expenses, etc.) that may affect the care they receive and the medical services they are eligible for. This process requires a diligent approach to understanding the implications of the coverage updates, reviewing policy updates, and ensuring that the billing team is aware of the impact on patient care and the healthcare revenue cycle.
The insurance tracking process usually has the following steps:
- Checking insurance terms and regulations – this can be done by checking insurance portals, subscribing to industry newsletters, attending conferences, and following relevant blogs. Make a habit of doing reviews regularly; this can be a weekly or monthly task depending on the volume of insurance providers.
- Reviewing policies – once you see an update, review your patients’ policies to see if the changes impact their coverage.
- Verifying patients’ eligibility – verify your patients’ insurance eligibility and make sure you will get reimbursement before providing any services.
- Documenting changes in policies and eligibility – record all the updates to keep track of any changes that may impact other patients or future care.
There are several tracking methods available, including manual tracking, which is the most basic, using spreadsheets or documentation tools. It seems simple and low cost, but it is very time-consuming and likely to have errors. For businesses with large or complex insurance portfolios, manual tracking is not practical. The best solution is to use software to track changes in insurance policies, which will send automated alerts and notifications when any changes occur, resulting in very efficient healthcare revenue cycle management. Such software tools usually have affordable costs and have proven to achieve a high return on investment in healthcare.
How Can I Build an Effective Tracking Process
To improve the change tracking process, there are a few key pieces of advice that can be helpful:
1. Automate where possible: Technology has revolutionized the healthcare industry, making it easier than ever to manage billing processes. Automated software can help streamline the entire process, from tracking changes in insurance policies to generating invoices and submitting claims, freeing countless hours for staff. Consider using tools like Approved Admissions to automate the coverage change tracking process. Such tools can proactively monitor policy updates and changes, and alert staff members when changes occur, helping to prevent mistakes and improve healthcare revenue cycle management.
2. Stay organized: Keep all insurance policy documents in one place and ensure that they are easily accessible to staff members who need them. Use a tracking system to keep tabs on the latest updates and changes, and make sure that personnel can access this information.
3. Monitor claims: It’s important to monitor sent claims and follow up with insurance companies if there are any delays or denials. This can be done manually, but it’s much more efficient to use software that provides real-time tracking and notifications for claims that require special attention.
4. Provide additional training for billing staff: Deeper knowledge regarding proper insurance coverage and tracking will improve job efficiency. Several resources provide useful training programs for healthcare revenue cycle professionals:
- NAHAM – The National Association of Healthcare Access Management
- CMS – Centers for Medicare & Medicaid Services
- HFMA – Healthcare Financial Management Association
- NAHRI – National Association of Healthcare Revenue Integrity
5. Communicate effectively: Make sure that all staff members who interact with patients are well-versed in the topic and can communicate any updates or changes in a clear and concise manner. This will prevent confusion and ensure that patients receive care without delay.
Effectiveness of coverage changes tracking can be measured in a few ways:
- Efficient billing processes: Robust claim and denial management (including correcting errors and resubmitting claims when necessary), comprehensive insurance verification, improved accuracy of data entry, clear patient communication, and streamlined payment processing.
- Reduction of claim denials: The billing team will be constantly up to date and ensure that claims are submitted correctly thanks to increased accuracy in coding and billing, resulting in a decrease in denials and cuts in medical billing costs.
- Improved patient care: If the team can keep up with the changes and inform the patients promptly, it can help alleviate any potential disputes and improve patient satisfaction with the services.
- Improved regulatory compliance: Effective tracking ensures that the facility is compliant with the latest policies, avoiding potential penalties or legal issues.
Improve Financial Performance with Automated Coverage Tracking
The primary benefit of an efficient automated coverage tracking system is the reduction of potential losses and optimization of the medical billing revenue cycle. It can be reflected in a few ways.
Expedite payment processing: Discrepancies and errors are the main reasons insurance companies deny claims, resulting in delayed or rejected payments. With automatic coverage change tracking, providers can ensure they are meeting the insurance company’s billing requirements, thereby expediting payment processing and improving cash flow. Faster payment processing decreases the duration of the revenue cycle, while improved cash flow helps providers manage expenses, pay staff, and invest in new technology that can further improve patient care.
Missed opportunities prevention: If coverage changes and the healthcare provider is unaware of it, they may continue to bill the old insurance plan. Thanks to a tracking system, providers can ensure they are billing the correct plan and avoid missed revenue opportunities. Furthermore, the billing team can promptly identify new opportunities for additional revenue. For instance, if the updated insurance policy covers a certain type of service that the medical facility offers (which wasn’t included in the patient’s plan before), the team can start billing for this service to maximize the organization’s healthcare profit.
Improved contract management: Automated tracking also helps facilities better manage contracts with payers, ensuring that they meet their requirements and send claims appropriately. This results in improved contract performance and good relationships with insurance companies. Additionally, data from the automated tracking system can be used to identify patterns and trends in coverage changes, enabling facilities to make informed decisions about payer contracts and negotiate better reimbursement rates.
Healthcare billing automation systems like Approved Admissions can significantly help in achieving better financial goals, offering an automated coverage change tracking tool. It proactively sends convenient email notifications to the billing staff when changes occur, making it possible to do real-time monitoring of insurance policies. This gives the team enough time to make changes before the next billing cycle, prepare, and send clean claims, maximizing revenue. Such software can easily integrate with existing business processes and electronic platforms thanks to RPA-powered connectivity.
