The healthcare landscape is rapidly changing, and sitting with a front seat view is the hospital business office. The uncertainty of ICD-10, healthcare reform and changing reimbursement rates, payer rules, compliance regulations…it's a lot to take in. A business office needs to be adaptable and ready to make adjustments. With the advantage of evolving technology around claim submission and editing, that includes adjusting the roles of its personnel, namely the medical biller.
Let's look at a snapshot of how a medical biller once functioned. As claim submission is both complex and incredibly important to an organization's revenue, a biller was a fundamental, high-level position, requiring thorough understanding of complicated payer rules. He or she often needed to review each claim before it went out the door to ensure it was correct. This was the best defense against payer denials. However, there are many reasons this approach is ineffective:
Today, your claims system can be and should be handling your claim editing. Payer rules should be built right in to the system, ensuring claims go out correctly the first time. Time spent on the actual billing function should be minimal. So, what can you do with your billing staff?
Compliance is another huge consideration. An organization needs to be aware of and track the changes being made by the biller handling the claims as a safeguard against non-compliance that could be costing reimbursement. If they are routine changes, they can be automated within your claims system.
The best defense against denials and the most effective way to increase cash and shorten the revenue cycle is to use your billing staff in new ways. The title of medical "Biller" implies heavy emphasis on billing, but today's billers really should be spending little time on billing - instead using their expertise to solve A/R issues and denials.
Visit www.efficientC.net to learn more about efficientC claims processing system.