Author: Divan Da've
Doctors work in a competitive and changing environment. Consumers are more demanding, regulations are more stringent, costs are rising and government reimbursement is constrained. On the other hand, increased use of IT tools has revolutionized the profession by enabling efficiency in the practice workflow. There remains the problem, however, of gaps between the medical practice, its back-end systems and the physicians.
The primary concerns for a medical practice are:
• Documentation
• Revenue
• Increasing Overhead
A medical billing service is a doctor's key to getting paid. Although the medical profession is adopting various systems to streamline workflow, most doctors are still finding it difficult to get paid fairly and quickly.
In addition, insurance companies regularly change their medical review policies with respect to claim payments. Rejected claims due to non-compliance or submission errors result in a decrease in reimbursement and, hence, revenue.
It is essential that the practice be well organized and control its practice management processes efficiently to ensure profitability. It is important for the practice to recognize and address the various bottlenecks present in its workflow and information management. The need is to streamline workflow and documentation, improving communication and reducing wasted time and resources associated with patient visits.
Integrating Medical Billing with EMR
With the increasing acceptance of EMR by physicians, it is essential that they adopt a system that automates the entire billing process – starting from point-of-care through reimbursement by the payer. Information technology has provided the tools required to efficiently manage a practice.
To date, there is a tendency to have multiple systems carry out the different operations of a practice – EMR for clinical documentation, practice management for billing and financial administration, document management for patient reports, appointment scheduler for appointments and so on. Therefore, integration of such islands of data is essential to get the maximum benefit of technology. This will ultimately increase the efficiency of the billing process, leading to an increase in cash flow by creating an end-to-end solution that ties together the entire physician office from scheduling to treatment and finally, to billing.
Advantages of Integration
· Easy to Use and Easy to Manage
Once a patient record is entered in the EMR, the information is automatically shared with the billing system. Redundant entries are automatically eliminated because access to all patients' demographic and insurance information is quickly distributed from one central point to other modules. Procedure codes, diagnosis codes and other information added just once during treatment are made available for billing. Super bills with procedure and diagnostic codes are transferred to the billing system and can be used to generate and send claims.
· Improve Cash Flow and Collections
Physicians can quickly and easily select the proper procedures and diagnoses and create electronic super bills right at the point-of-care. While capturing the charge, the software checks the accuracy of the CPT and ICD codes to ensure wrong charges are not sent to the insurance company. Some systems come with an E&M wizard for capturing appropriate level of coding. This creates complete ‘super bills' with the right coding. As a result of direct integration, with all the required fields filled out correctly, the practice is able to get claims out in just a few minutes, instead of the usual day or two.
· Practice and Patient Reporting
Integration of the billing system with EMR helps in generating customized reports. Easy access to all supporting documents/reports required for claim processing helps in managing the entire process in a far more effective way - compared to a stand-alone billing system. Also in case of audits, complete patient charts and documentation is available for verification.
· Online Insurance Eligibility Check
Some EMR providers also offer the facility of instant online check for insurance eligibility to verify a patient's medical benefits. This information provides assurance that the insurance record on file is current before services are delivered. The feature streamlines the patient registration process - claims are sent to the right insurance carrier, thereby decreasing the number of rejected claims, fewer days in AR (accounts receivable) and ultimately resulting in increased revenue.
All these advantages lead to an increase in revenue generation in much less time compared to any other conventional method used for medical billing. Integrating billing with EMR reduces the large amount of associated paperwork, the problem of collecting from non-paying patients and the overall collection costs. Streamlining practice workflow in this way will enhance productivity, efficiency and quality of care.