Even though the medical industry is facing a massive overhaul, revolutionizing the way patients are treated, clinicians find the time spent in the medical billing insurance claim process – documentation, following up, and waiting – is longer than the time of service they provide their patients with.
No medical practitioner is unknown to the challenges medical billing claim process puts forth, taking an average of 30 – 45 days to pay claims, which is an excruciatingly long period of time. Complex as the world of healthcare is, issues related to medical billing eclipses the growth of medical practices, dampening not only its sustainability but its personnel’s spirits
Medical billing as it is puts forth a slew of challenges, add the factor of no technology and the whole procedure becomes almost onerous. Over the years we have witnessed technology being the savior of one industry or the other, so medical billing doesn’t fall too far behind. While technology is already inevitably being used in the medical industry, here are some upcoming technological trends which are set to streamline the medical billing insurance claims process, giving practices an edge over their business.
1. Clinical Documentation Improvement
Although, a claim denial can be attributed to quite a few factors, improper transcription stands to be the number one reason behind it. Something as trivial as an incorrect spelling, or an error with the date of birth can result into a denied claim, which to be sent for reevaluation will take at least 15 days. Submission of correct information is crucial, as insurance companies can’t validate the patient without this relevant data. So, the dire need of documenting correct patient information is evident.
A research conducted in 2016 by the American Medical Association (AMA) shows that the amount of time a medical practitioner spends on medical billing insurance claims documentation is twice the amount of time he spends with a patient. In addition to that, it was also found out that medical practitioners that haven’t gotten onboard with a billing company, spend two hours extra on documentation after working hours. These tedious documentation standards keep doctors from narrowing their focus on patients and perfecting their craft and instead keep them buried under a pile of paperwork.
The number of error free claims will rise if medical practitioners can minimize improper transcription, in turn, boosting practice’s revenue and reducing the associated cost. Clinical Documentation Improvement is geared towards helping practitioners achieve that by recording all the pertinent patient data received during the initial encounter.
In an interview, manager at Black Book Market Research, Doug Brown claimed that Clinical Documentation Improvement is crucial not only for insurers but also insurance payors. Study carried out by his company reflected that by implementing CDI in their practice, around 90% of medical practices with an average of 150 beds were able to see an improvement of approximately $1.5 in their revenue.
Blockchain – the technology that was initially introduced to back a decentralized payment network – is now talk of the town. There are many implications of blockchain in the medical billing industry. For one, blockchain safeguards patient data. The need to secure patient data is imperative considering how critical it is. With the elimination of an intermediary and provision of a transparent channel, blockchain has made the channel quite secure for the patient. But that’s not the only benefit blockchain has for the healthcare industry. Since interactions on blockchain happen in real-time, the claim process becomes incredibly fast, especially since there isn’t a third-party that needs to be relied upon.
In addition to that, yet another benefit that blockchain provides healthcare practitioners with is the ease of detecting fraud and embezzlement. This is due to the fact that blockchain has a transparent trail that can be monitored and any irregularities can be spotted.
3. Artificial Intelligence
Till circa 1980, billing experts used to rely on encoders to transcribe the medical record of a patient. Medical experts from having to manually type in all the information to moving towards encoders was definitely a step in the right direction, indicating a progressive move. Even though, encoders made it incredibly easier for healthcare professionals to type in codes, owing to their ease of use, change is the only constant, which is why, technology continued to disrupt healthcare to make it better than it originally was. So, a change that was put forth in 2015 was the alteration in codes. Most medical practitioners were against this change, claiming that the transition cost has been estimated to be between $56,639 to $226,105. In addition to that, a plethora of claims was rejected due to coding errors.
Today, medical practices rely on cliff notes for the coding purposes. Cliff notes are basically computer-generated codes that are created once the details of a patient and service are fed into the system.
However, what initially started as a means to expedite the coding process is now attributed as the reason behind the slew of errors that come up. So, the dire need for a coder remains present regardless of the developments in healthcare. A study shows that these errors are annually priced at $750 billion.
With artificial intelligence disrupting every facet of our lives, the impact of AI on healthcare remains inevitable. You may have come across the news of Alexa soon being able to tell if you are sick or down, but that’s not the only development of AI in the healthcare industry. It is doing wonders for the medical billing sector as well. Many medical practices have started making use of AI for the development of machine learning and artificial intelligence-backed computer assisted coding (CAC) systems. By giving real-time feedback, medical practitioners can assist coders. The potential of AI in the medical billing industry is enormous, which is why it is estimated that the industry for AI tools will be priced at $6 billion in the year 2021.
The implications of technology in the medical billing insurance claims process are evident, however, for medical practices with limited resources, it is not always convenient to purchase the latest technological tools. One way to tackle this problem is to get onboard with a medical billing company, which not only has extensive experience in the field but can also help you optimize cost significantly.