Automation of both eligibility and prior authorizations are having a considerable impact on the world of healthcare. The simplification of these processes has made life a lot easier for both patients and practices alike. Let’s discuss some of the most significant impacts of the trend of automation when it comes to eligibility and prior authorizations.

 

1. Improved Efficiency

The eligibility process has been made considerably easier by the automation of some of its more arduous aspects.This means less paperwork and phone calls, and less human error. Of course, anything automated is not only going to get done faster, but be free of pesky human errors that plague any manual process. Automated systems verify coverage upfront, allowing providers to bill more accurately and promptly, resulting in faster reimbursement, improved cash flow, and more efficient billing process.

Additionally, many eligibility automation systems can often be integrated with existing electronic health records (EHR) or your practice management system. This integration eliminates the need for duplicate data entry, improves data accuracy, and ensures seamless information flow across different processes and departments.

Automated eligibility also makes life easier for your patients, as you can provide them with more accurate information about their insurance coverage upfront. This enables your patients to make informed decisions about their healthcare and avoid unexpected financial burdens that may decrease collections and damage your revenue cycle.

In terms of authorizations, ePA systems can almost completely automate the prior authorization process, eliminating the need for manual paperwork and phone calls. ePA systems also facilitate real-time communication between healthcare providers and insurance companies. This allows for quicker processing and response times, resulting in faster approval or denial decisions. Implementing electronic prior authorization enables you to operate more nimbly than your peers. However, it is important to note that not all insurance companies have fully adopted electronic prior authorization, so although you shouldn’t completely abandon manual processes for now. Some aspects of the process like case review will remain human for now, but don’t expect the trend of automation to go away anytime soon.

 

2. Reduction In Claims Denials

Although we touched on it in the first section, automating eligibility and prior authorizations helps save your practice from costly claim denials, and makes your billing process more frictionless.

Automated eligibility checks can be performed in real-time, allowing medical providers to quickly verify insurance coverage before providing services. This helps avoid denied claims and facilitates faster reimbursement for services rendered.

ePA systems help minimize denials and billing errors by improving the accuracy and completeness of prior authorization requests. Your electronic prior authorization platform can incorporate validation checks, ensuring that all required information is included before submission, increasing the chances of successful authorization and reimbursement.

 

3. Reduced Administrative Burden

Technology has made it easier to access and compare healthcare prices. Healthcare price transparency tools, such as online databases and apps, allow patients to compare prices across different providers and make more informed healthcare decisions.

In addition to decreasing time spent on manual tasks in the prior authorization process, electronic prior authorization eliminates the need for printing, mailing, and storing paper documents associated with prior authorization requests, reducing clutter and helping your practice become paperless. If you are looking to maximize your practice’s efficiency, you should certainly look into automating the prior authorization process.

Automating eligibility verification and prior authorization can help take your practice to the next level. To do so, you’ll need some great clearinghouse partners in your corner. We work with TriZetto Provider Solutions, Waystar, and Claim M.D, in particular.

 

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Automating eligibility verification and prior authorization can help take your practice to the next level. To do so, you’ll need some great clearinghouse partners in your corner. We work with TriZetto Provider Solutions, Waystar, and Claim M.D, in particular.

If you are looking for a way to improve your practice’s revenue cycle management and make your billing process more efficient, EZClaim can help. Our industry-leading medical billing software has everything you need, and nothing you don’t: all to make the billing process as simple as possible. If you are interested, we encourage you to schedule a free demonstration to learn more! If you want to pursue automating the eligibility verification process, we have some outstanding partners who can help you in that journey.

Price transparency is an increasingly popular trend in the world of healthcare. The term “price transparency” refers to the ease with which consumers can obtain detailed price and market information of different products. The Hospital Price Transparency rule went into effect Jan. 1, 2021, requiring hospitals to post a comprehensive machine-readable list of their services and prices as well as a patient-friendly tool to help shop for 300 common services. Although it may not impact what medical billers do on a day-to-day basis, it is sure to have a large impact on the industry as a whole. So, why is price transparency becoming more common in healthcare?

 

Increasing Healthcare Costs

Healthcare costs have been rising steadily over the past few decades, and patients are increasingly bearing a larger portion of the financial burden. As a result, patients are demanding more transparency in healthcare pricing to better understand the costs associated with their care. Cost of care plays a massive role in whether someone seeks treatment or not. The rise of price transparency has already had a considerable impact on behavior in this regard. Before 2021, 44% of people avoiding obtaining health care were doing so because they didn’t know what it would cost. In 2021, only 25% of people reported avoiding care because of cost uncertainty.

 

Consumer-Driven Healthcare

Another trend fueling the price transparency wave is healthcare becoming more consumer-driven, meaning patients are taking a more active role in their healthcare decisions. Patients are increasingly seeking out information about healthcare prices and quality in order to make more informed decisions about their care. As mentioned previously, when information in regards to cost is readily available, people are more likely to seek out care.

Price transparency can also greatly improve the trust and overall relationships patients have with providers and ultimately promotes better outcomes and satisfaction.

 

Technological Advancements

Technology has made it easier to access and compare healthcare prices. Healthcare price transparency tools, such as online databases and apps, allow patients to compare prices across different providers and make more informed healthcare decisions.

 

How Will This Impact Medical Billing?

Fewer Phone Calls: Price transparency is important for promoting accountability and reducing the incidence of surprise medical bills, which can be a significant financial burden for patients and their families. Expect to get fewer calls to your practice about surprise charges.

Patient Responsibility After Insurance: As price transparency becomes more widespread and accessible there will most likely be more preservice collections of estimated patient balances. If patients are aware of their costs upfront and have more time to plan for those they are more likely to pay those either before or at the time of service. This will reduce the effort and time that medical billers would typically have to spend on collection efforts after services are already provided.

Efficiency: On the other hand, price transparency could also benefit medical billers by increasing their efficiency in billing and collections. With greater access to pricing information, medical billers can more easily identify and correct errors in billing and ensure that patients are being charged accurately.

New Tools: Clearinghouses are now offering comprehensive tools that help practices get data directly from payers in a very efficient manner. One such tool is TriZetto’s Patient Responsibility Estimator. This tool enables practices to generate real-time financial estimates for their patients. This creates complete transparency that empowers patients to be more proactive when managing their cost of care, making it more likely that your practice is able to collect payment.

 

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If your practice is curious about how price transparency will continue to impact the industry, we’d love to speak with you. If you are looking to offset the cost of making pricing information available and improve your medical billing process at the same time, we can help. EZClaim is a low-cost medical billing software that has everything you need, and nothing you don’t. Our intuitive software helps practices and billers alike become more efficient. Schedule a consultation today to learn more!

Data privacy is another prominent trend in the medical billing industry, and for good reason. With bad actors looking to steal data wherever they can, medical practices and billers can be prime targets. To combat an increased need to protect the data of their patients, practices and billers are implementing robust security measures, making changes to their data collection and storage practices, and being more accountable and transparent in their handling of patient information. More time and resources than ever are being invested into ensuring compliance with ever-changing and evolving regulations.

In this blog, we dive into why the issue of data privacy is so important to your business.

 

Ensuring Compliance

There are myriad rules and regulations regarding patient privacy for a reason. Non-compliance is a very serious matter. An organization that is not in compliance won’t simply be able to claim ignorance, and even if it does, there are potential criminal ramifications.

There are four tiers of HIPAA violations that range from small fines to ones of over $50,000 (minimum, per violation). An organization with several tier four violations can find itself on the hook for up to nearly 2 million dollars in fines in a single year. Very few businesses can withstand such a blow financially, let alone reputationally.

In some cases, a violation can be characterized as criminal, not civil, and even include penalties like jail time.

It is pivotal that your business remains in compliance, as falling out of line can mean the end of your business, or worse.

 

Preventing Data Breaches

Cybercriminals are becoming more sophisticated, and you need to be sure your systems and security can keep up. Medical billing systems are a prime target for cybercriminals because of the valuable patient information they contain, from credit cards, to medical history, to social security numbers. A data breach can result in the theft or exposure of patient data, leading to identity theft, fraud, and other serious consequences.

Moreover, a breach can be catastrophic to your business’ reputation. No practice or biller wants the reputational damage associated with its patient’s personal information being leaked.

To prevent data breaches, medical billing systems must have robust security measures, such as firewalls, encryption, and access controls. Your business should spare no expense on ensuring you have best-in-class technology and minds behind your security.

 

Building Trust

Your relationship with patients is the most important aspect of your practice. Your patients share confidential information that they likely wouldn’t share with others. It is pivotal that you take care of this information, and keep it private.

Your patients need to be certain that their medical information, including test results and diagnoses are safe in your hands. If this is not the case, they will take their business elsewhere.

It is critical that you do not undervalue how important data privacy is to your patients. Remember, you are one breach away from disaster, and decades of good-will being torn to shreds instantly.

 

How to Promote Compliance

There are two primary ways your business can promote compliance with all data privacy/security requirements:

1. Protecting Your Systems: There are countless productive steps your practice or billing (RCM) organization can take to ensure you are taking proper care of patient data

Some of these include

-Extensive password protection
-Regularly updated firewalls and antivirus software
-Access to a secure data-backup source
-Encryption for transferred files
-Information access control/authorization protocol
-Regular technical evaluations to assess threats and potential issues
-Physical safeguards

2. Training Your Employees: When it comes to training your employees, there are two primary buckets you should be focusing on:

Training on your organization’s policies and procedures: General, low-cost training that answers basic questions like “what is HIPAA” is not going to go very far in ensuring compliance. Your employees need to participate in comprehensive, ongoing training specific to your organization and its procedures. This should contain a thorough exam that team members must pass to demonstrate their understanding.

Remember: your organization can have the best compliance program in the industry, but if your employees don’t know about it, it is very easy to slip into non-compliance and encounter major issues that can sink your business.

Training regarding privacy and security as it relates to HIPAA: In addition to company policies and procedures they’ll encounter in their day-to-day, your team should also have a robust understanding of HIPAA itself, and what is and is not compliant.

If you are curious how your organization can improve its compliance, Live Compliance is an exceptional resource and partner for getting you where you need to be.

 

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Are you sure your medical billing system is safe and secure? If you have any doubts, your business is likely in a compromising position. EZClaim is a cloud-based, secure medical billing software that you can access from anywhere, but only with the right permissions. Our top priority is keeping your data secure, and ensuring your business runs as smoothly as possible. Schedule a free consultation to learn more about how EZClaim can transform your business!

In the modern day and age, bills are paid online. From car insurance to college tuition, online payment portals have become the best way to facilitate bill pay options. Even stodgy old landlords have allowed their property managers to set up online payment portals. However, in the medical industry where receiving payment is a primary pain point, many patients struggle to pay bills simply because there is no 24/7 bill pay option.

Most people pay their bills at home, after work, and often late at night during their final to-do checklist. Others pay their bills at work between other online tasks. Coming into the doctor’s office or medical facility to write a check is just not on the menu. Many don’t have the time, and for most, it’s now a complete detour from every other life routine.

If your medical practice does not yet have a 24/7 online bill payment option, it’s time. Let’s take a deeper look at the many reasons why medical procedures need this essential billing upgrade.

 

Digital Accessibility: Patients Who Can’t Make It In

Accessibility is a medically profound reason to switch to anytime online and phone bill payments. However, not everyone can make it into the doctor’s office to pay their bill. It is likely that not all your patients are fully mobile, can drive themselves, or can schedule a quick trip to the office to pay their bills. Supportive families and caregivers may not have the time, or the scope, to take care of in-person bill payments for them. Requiring patients to pay in person is a reliable way to ensure that some payments will be late or missed due to accessibility issues alone.

However, even if you have online or phone bills pays within office hours, this can also be an accessibility issue. You must include patients who work the night shift or whose work hours 100% exclude your office hours. People lose enough of their work hours to medical appointments without needing a second appointment to pay their bills.

 

The Medical Industry is Behind the Curve

The medical industry is notorious for technological lag, using tried-and-true methods long after the world has adopted the next big thing. But this one upgrade is no longer an option and does not require a huge data migration of secure files. Allowing online and phone 24/7 bill payment has become the industry standard – and has been for over a decade.

According to Insider Intelligence, 85% of patients prefer electronic payments for medical bills, while 65% of patients would consider switching medical providers if paying bills was easier. Medical billing is struggling to get payments from patients who can and are willing to pay. This is because payment has become inaccessible compared to the way all other modern bills are handled. Medical bills are now ranked with traffic tickets as difficult to get paid even when patients desire to pay the bills.

 

Increase Immediately Available Revenue for Your Medical Practice

Of course, it’s not just about customer satisfaction, or being behind on the digital transformation. It is always about collecting enough revenue to keep the lights on and your staff paid. Medical practices often struggle with finances and billing. Insurance companies like to reject claims and many patients have genuine financial troubles. Online bill payment takes one very important block out of the path to your team getting paid for medical services you work hard to provide to the community.

When patients can easily log in and pay their medical bills, often as soon as they get the statement, their immediate access to revenue goes up. These are bills that are paid promptly instead of waiting for months. They don’t get forgotten, they don’t go into collections. You just cross one payment off your list, mark the patient as paid in full, and enjoy the revenue as it arrives.

 

Hop on the Gravy Train: Inclusion in Monthly Bill Pay Routines

Another great reason to upgrade your medical practice to 24/7 and online bill payment is the “gravy train” effect. Many people sit down and pay all their accumulated bills at once. It simplifies the bill pay process and can be done just by sitting at the computer for 15-90 minutes once or twice a month. They pull out their payment cards, type in the information, balance the household budget, and call it done.

Your medical practice’s bills should be included in that routine. They could be. Every patient who routinely pays all their bills online would just as easily pay for the services provided by your practice – if it were that easy. However, setting aside an envelope or email to pay in person or during office hours drastically decreases the likelihood that this bill will be paid – on time or otherwise. It’s just not included in the usual to-do routine. However, with online payments, your practice could easily hop on the gravy train of routine, responsible bill payers.

 

Automated Online Bill Pay

Many medical facilities are also missing out on the opportunity to set up automated medical payments. Financially stable patients often have no problem setting up yet another automatic monthly bill to pay off significant procedures or accumulated medical expenses slowly. In fact, even patients who struggle financially may appreciate automating their payment plans. Not only are you making payment easier (the easiest possible) for patients, but you are also creating a reliable and assured revenue stream for your medical practice.

 

Payment Options Decrease Technical Roadblocks

Most medical practices have faced more than a few billing roadblocks. Technical difficulties, bureaucratic slowdowns, phone system failures, and in-office computer errors can all prevent patients from paying their bills, even if they come in during office hours.

However, the more payment options available, the more likely your patients to find a workaround to pay medical bills anyway. For example, if the office system is down, paying by phone might work. If the phone system is down, paying online might work. If paying by card doesn’t work, PayPal and separate digital payment providers may come through. The more options available, the more payments make it through technical roadblocks. Then, many patients will do the troubleshooting for themselves with at-home access to payment methods.

 

Payment Options Decrease Technical Roadblocks

The good news is that upgrading your medical practice’s bill payment options doesn’t have to be a big ordeal. With convenient and swiftly integrated systems like BillFlash Pay Services powered by EZClaim, you can add easy online and mobile bill payment, automated payments, an integrated in-office payment system, and a gateway for merchants as well.

Give your patients the 24/7 online, mobile, and automated bill payment access they have come to expect. Then, reap the rewards in more reliable and timely revenue for your medical practice. Schedule a consultation today to discover how BillFlash Pay Services powered by EZClaim can work for your practice, facility, and revenue stream.

Another rapidly growing trend in the medical billing industry is the emergence of web-based or “cloud-based” software. As practices and billing firms (RCMs) alike look to become more efficient and better control the billing process, organizations are switching to web-based softwares as an integral part of that mission. Let’s dive into some of the key factors fueling the rise of web-based medical billing software.

 

1. Accessibility

A major draw of web-based medical billing software is that it can be accessed from anywhere with an internet connection, allowing practitioners to work remotely or from multiple locations. This enables quick connection for everyone involved in the medical billing process. As you have access to the internet, you are connected to your billing process, whether you’re at home, at the office, or on a tropical island.

This visibility is remarkably valuable to businesses, and also allows for improved patient treatment. Clinicians can access patient health data from anywhere, and can rest assured that all the information they are looking at is up to date. It is in the best interest of any practice looking to improve the patient experience and effectiveness of care to ensure their software makes information as readily available as possible.

Using a web-based software also enables you to hire billers from anywhere in the world. Since your data can be easily accessed, you aren’t limited in terms of who you can hire (from a geographical perspective).

 

2. Automatic Updates

Web-based medical billing software is updated automatically, eliminating the need for manual updates and ensuring that practitioners are always using the latest version. As the software evolves and receives a more robust feature set, your organization will reap the benefits without any cumbersome steps needed.

 

3. Scalability

Web-based medical billing software can easily be scaled up or down depending on the needs of your practice/RCM, making it more flexible and adaptable than traditional software. If you intend on growing and processing more claims, you need a software solution that is able to grow with you. Using a web-based software ensures your practice won’t be held back by its software.

Additionally, your business won’t need to spend money up-front on servers, an IT department, and hardware. A cloud-based solution simplifies your operations, and makes it easier to scale.

Web-based software tends to be easier to use and more intuitive than traditional software. You won’t need highly-specialized training in-person training from an in-house team member, as cloud-based software typically provides comprehensive onboarding to ensure you’re ready to go as quickly as possible.

 

4. Collaboration

Web-based medical billing software allows multiple users to work on the same project simultaneously, facilitating collaboration and improving communication among team members. This improves overall operational efficiency, and allows you to process more claims in less time.

 

5. Security

Web-based medical billing software providers typically offer data encryption and other security measures to ensure patient information is kept confidential and secure.

Another key security benefit of web-based software is the peace of mind it provides from a data backup perspective. If you are using a traditional software, and are faced with an unfortunate situation like a fire or other disaster that damages your office or hardware, you are at risk of losing all of your records. Storing your data on the cloud ensures it cannot be lost, and is with you wherever you have internet connection.

 

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If your business is exploring the possibility of switching to a web-based software, we’d love to chat with you. Schedule time to meet with our team so we can discuss your needs and how EZClaim can help.