How (and Why) Should You Build an Automated Medical Billing System?

Billing is the lifeblood of any healthcare practice. For the most part, medical billing can be a very complicated and work-heavy procedure with a lot of repetitive processes, but what about implementing an automated medical billing system?

Medical Billing Process

This repetitive nature of medical billing makes it a great candidate for automation and coupled with the fact that several organizations are under pressure to keep the medical billing process as efficient and reliable as possible.

In this article, we talk about automated billing system in the medical industry, its importance, and the processes involved.

Automation takes care of every important aspect of medical billing that might seem tedious to a human. Billing errors get identified before a claim is submitted which results in claims getting paid faster by payers. Similarly, RPA payment solutions can be employed to enhance collections by automatically sending bill notifications to patients through text or email.

In the United States alone, a large amount of money is being spent yearly on healthcare expenses that can be avoided. The following are some of the reasons why automated medical billing is very important.

In an industry where Paper document filings involve spending $20 per filing process. Healthcare providers fill out an average of 20,000 forms yearly, and in medical billing where lots of administrative paperwork like patient profile creation and registration, eligibility check, and other billing information validation are being filled daily, error-free documentation should be the goal of every healthcare provider.

Similarly, automation enables providers to comply with HIPAA and other regulations and also reduces the number of staff members dedicated to a process while increasing productivity.

Take RCM, which is the financial process of collecting payments for medical bills to generate revenue for a healthcare organization. Revenue cycle management can be time-consuming and expensive because it combines administrative data such as a patient’s personal information, treatment codes, and insurer name with financial billing information. The recommended amount of receivables older than 120 days should be between 12-25 percent, but automating RCM tasks aids in lowering it to less than 12 percent.

All healthcare providers that have jumped on the RPA train in Medical billing automation can attest to the fact that using an outdated billing system risks a high level of unorganized claims processes and unnecessary errors. In 2021, $28.91 billion in payment errors were made as a result of coding errors according to the Centers for Medicare & Medicaid Services (CMS).

If you’re from IT consulting industry let us show how can you benefit from automation in consultancy for medical billing.

A lot of tedious and repetitive processes can be automated in Medical billing. Let’s take a look at the most important ones.

Automation can simplify patients scheduling processes wherein all appointments and registrations from the beginning up until the point of completion of visit or consultation will be sorted by RPA bots.

This is arguably the most important part of an automated medical billing process. Healthcare providers have to sort through disparate technology systems to source miscellaneous data such as entries from patients’ medical history, drug and disease codes, and insurance eligibility. Afterward, reimbursement is then received based on the accuracy of medical billing codes. If the process isn’t implemented accurately, payments might not reflect.

Learn more about Revenue Cycle automation with RPA.

To help remain HIPAA compliant and minimize security risks while also facilitating a successful doctor-patient relationship, healthcare companies have to embrace automation and integrate RPA within their system. Besides, penalties towards HIPAA violations are quite severe, be it the healthcare providers’ fault or not.

Omissions and errors as regards document-related issues are not far-fetched because the majority of the procedures require filling specific information approved by patients and usually involve chasing people down to get approvals. All these usually lead to skipping some procedures and making the simplest errors. However, perfectly implementing RPA promotes automation in the healthcare workflow, to help transfer patients’ data automatically.

Read more about HIPAA compliance automation.

Claims processing automation like keeping fees schedules up-to-date, remittance, tracking claims, and posting of payments can ensure accurate payments so that no claim goes unpaid or underpaid. Leveraging RPA in claim processing can take your company clear of any kind of loss you may incur as a result of underpayments.

Learn more about automated claims processing.

Regardless of the type of Electronic Health Records software your company is using – there is always a room for automation. Consider the following example:

Medical billing might seem a lot complicated, but it’s a process that comprises the following eight simple steps.

This is the first step of the medical billing process where a patient calls to set up an appointment with a healthcare provider. For a doctor’s visit, a patient has to effectively pre-register by providing insurance details. Information of old appointments will be already saved and a patient only has to explain the reason for their visit on subsequent visits. Registration enables medical billers the opportunity to verify details provided before claim submission.

Financial responsibility checks are carried out to verify a patient’s insurance to know who owes what for a doctor’s visit. Before a biller can determine if a patients’ insurance plan covers the kind of services the patient needs, the biller has to gather vital information which can only be carried out by carrying out financial responsibility checks.

Individuals and companies all have different insurance plans, so a biller has to check a patient’s coverage to ensure certain bills are assigned appropriately and prescriptions are covered for the entirety of the bill. In this case, RPA bots are used to carry out these kinds of checks.

Patients are asked to fill out forms as they arrive to separate registered patients from first-timers. The necessary official identification such as a valid insurance card along with a passport or driver’s license is used in determining whether copayments are received before or after the enrollment is done by the providing office.

In most cases, Co-payments are collected at the point of service and once the patient has been verified, a report is sent to the medical coder. Upon receiving the medical report, the medical coder analyses the report and translates its information into usable medical code. This medical coding process results in what’s called the “superbill”.

The superbill includes demographic information about the patient’s medical history, the name of the physician, the name of the provider, the codes for the diagnosis and procedure, the procedures performed, and other relevant medical information. The superbill is then transferred via a software program to the medical biller.

After receiving the superbill, the medical biller transfers it into a billing software, or a paper claim form, and ensures that the procedures coded are billable, even though the billability of a procedure depends largely on the regulations laid out by the payer and the patient’s insurance plan.

Billers must also ensure that compliance standards are met. Typically the code must follow guidelines laid out by the Office of the Inspector General (OIG) compliance standards, and the Health Insurance Portability and Accountability Act (HIPAA). 

Transmission of claims is done electronically and with coding through the use of EDI (Electronic Data Interchange). The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates all health entities covered by HIPAA to submit their claims through electronic means. However, claims will only be transmitted through EDI if they are error-free. Learn how can you improve your claims management by providing RPA for claims processing.

This is the stage where a claim is either denied, rejected, or accepted. A payer evaluates the medical claim to decide whether it is compliant or valid and how much will be reimbursed to the provider. During the adjudication process, the details of the claims are sent to the biller or provider to know how much they are willing to pay and the reason why.

For patients that have secondary insurance, the remainder of the claim is sent to their secondary insurer after going through approval by the primary insurer. An appeal process can be filled with the payer if any problem arises.

Patient statements detail all the care the patient has received from their healthcare provider. It is the bill for procedures and once the payer sorts the agreed amount, the patient handles the rest. Some payers might include an Explanation of Benefits (EOB) to explain the reason some procedures were covered and others were not.

Bills have to be paid on time to ensure a system keeps functioning without issues. Billers are charged with mailing out timely, accurate medical bills, to ensure bills get paid on time. Each provider has its own set of guidelines and timelines when it comes to bill payment, notifications, and collections. It is the responsibility of the biller to ensure that the provider is properly reimbursed for their services if the patient does not pay the full amount or is delinquent in their payment.

Learn more about 5 processes for healthcare industry you didn’t know can be automated.

Having a streamlined and optimized workflow gives room for a less hectic work experience. Automated billing system helps healthcare providers significantly reduce human-related mistakes and process claims accurately.

Through the use of Flobotics automation services, our in-house RPA developers (including UiPath consultants) are ready to help optimize your medical billing process by syncing multiple health data with your company’s database. Get in touch with us to get RPA consulting services now!