Electronic medical billing: steps and insights

Here you will get a basic guide on the electronic medical billing services as well as their main steps, and our advice on how to do your best while taking care of its software.

A lot of clinics and hospitals today are struggling to keep their financial growth alive due to a margin cliff in the healthcare world where the number of aging people is constantly rising and governmental compensations are quite stressful in the traditional income sources areas.

If we have a look at the policy-making expenses account, it is worth more than 360 billion USD every year for the US medical system life cycle. A huge part of the budget goes to the billing services indeed. 

What electronic medical billing policy does to a healthcare business is impressive. Apart from time and budget saving, it makes patient experience better. It is so true, when a healthcare company is slow in digital billing software implementation, its business and profit risks to fail. 

Experts say that technology innovations investments like point-of-care solutions, remote patient monitoring or electronic medical billing software become more powerful in terms of  market competition, especially when economic times are not easy. We witnessed it during the Pandemic first year in 2020, a lot of people are witnessing it now after the Russian aggression against Ukraine began. 

It is worth mentioning that digital billing is not only for hospitals, clinics, and physicians’ offices. It works great also for third-party medical billing entities as the profit cycle gets much faster, naturally. 

Before we move further, to crown it all, let us pay attention to the definition. Electronic medical billing (EMB) is the most extensive practice in the United States when patients’ health claims are collected by a health care provider in a digital submission form. This way a payer like an insurance company can provide finances for the medical care. 

The advantages are crucial

Implementing electronic billing software brings much benefit both to caregivers and patients.

• Budget saving! Medical electronic billing services are less expensive than traditional billing because the digital records need little space and are more convenient than paper-based styles.
• Patient-centered approach. Medical professionals can give more attention to patients, customized workflows, less time spent in waiting, important regulatory updates in time, and more.
• Easy and paperless! Precious human effort is no longer involved in data management that usually comes in huge neverending amounts.
• The process became automated! Electronic health record in the key in the medical billing routine. The data is instantly synchronized with the billing scheme. This way redundancy is excluded and the data is fastly transferred to the obligatory units of EHR.
• More skillful and systematic records. The medical staff is able to reach a diversity of documents and charts and therefore tie up the billing to the current accounting plans.
• Electronic Medical Billing is transforming the look of the whole industry around the world. Health care givers move to the alternative billing systems more and more, consequently they get more opportunities to receive timely payments and ensure the profit.

Medical Billing Process Steps

The healthcare provider sends a claim to the payer via Electronic Data Interchange. The document must follow Electronic Data Interchange standards, otherwise it is going to be denied. Then the claim is studied by the payer where it is valid or not. Medical need is checked as well as the patient’s right to get the financial support, patient eligibility, and provider certification documents.

The rejected claim is not a tragedy though. The provider can fix all the issues, attach the previous claim, and apply once more. The procedure may repeat several times more, it is ok. Sooner or later, when everything is correct, the allowable sum of money is paid.

By the way, before providing medical services, hospital administrators can check a patient’s eligibility. Like in case of the claim submission, Health Care Eligibility & Benefit Inquiry transaction is a great help here. Naturally, the communication is digital, that is why it is a fast, easy and effective experience.

Software Implementation Scheme

Moving to an alternative medical billing model is a life changing choice that no doubt impacts a lot of medical practice areas. We want to share some crucial points for providers to think upon. Thorough planning, decent effort and supervision of each step will contribute to successful electronic medical billing software launch.

A detailed project plan and workflow adjustments

Planning comes first, naturally. Main goals and final results visualized, key team members and project leaders approved, a timeline created, and project needs and reliances studied.

It is vitally important not to miss any of the procedures during the big shift. That is why the ongoing billing operations must be investigated and documented carefully.

A proper financial plan 

Foreseeing all the possible project expenses is a great step when it comes to project presentation. Anyways, there will definitely be the need for routine budget revisions and improvements during the whole project development process.

In-house Communications and Engaging the Personnel

The successful workflow depends on a positive cooperation style between team members. A formal trigger, then regular updates, will make them tightly engaged, responsible and with a clear vision.

Selecting a Vendor

The process of investigation and choice is not so simple. The long term partnership is on the plate. After a great deal of research and negotiations follow a mutual project plan creation. 

Adopting the Software and safety policy

Your vendors will assist in fixing the steps for software implementation. Keep in mind HIPAA standards, data safety, plan B in case of a breakdown or data breach, etc.

Optimization processes

Now, when your healthcare business offers medical electronic billing services, it’s time for measuring efficiency against the accepted status of success, asking for team leaders’ feedback, and regular performance check-ups for the best experience.