Modernizing Medical Billing: New Ideas Outside the Incentive Programs

June 20, 2017 by Antonio Arias, MBA, CHBME

Topics: Meaningful Use Stage 2, Practice Management, Medical Billing Company

The U.S. healthcare system has a long-held (and well deserved) reputation as one of the most expensive, inefficient, and wasteful areas of our economy. For individual medical providers, the costs and complexities of medical billing, in particular, are so entrenched that they seem commonplace… and they also seem unlikely to change anytime soon.

Is it time for a more positive outlook among doctors and practice managers? The broad-based, government-spurred advances of recent years are beginning to make a difference at a macro level. For example, EHR use is creating better-quality billing data; HIE networks are decreasing duplicative service deliveries and improving care coordination; and the use of ICD-10 as a code set will continue to advance those benefits even further.

And while those changes have certainly been challenging for providers in terms of compliance, implementation, and education, they’ve also created new opportunities for innovation. Now that there’s a stronger, more consistent technological foundation supporting the healthcare industry at large, upstart companies and entrepreneurial doctors are aiming to improve care costs and financial efficiency without onerous government incentive programs.

After all, a more efficient medical billing system benefits all parties involved – patients, payers, and providers – which is why our medical billing service exists: To make the revenue cycle as productive as possible for our customers. Here are a few innovations and updates that our firm is excited about.

Automated Eligibility Checks

Eligibility checks are a proven to improve revenue outcomes, but many practices struggle to find the time to verify their patients’ insurance coverage in advance of each visit. Even when they do conduct checks, many providers do so manually – accessing potentially outdated information by phone or online – or fail to pass complete, accurate cost information to the patient up front, at the time of service.

When integrated directly with payer networks, real-time eligibility checking tools such as Eligible can eliminate such issues by providing transparent cost information to patients throughout the entire encounter experience – from scheduling and registration to check-in and check-out. Ultimately, that can minimize providers’ collection burden on the back end (and lead to fewer surprise bills for patients down the line).

Upstart Provider Networks

Staying independent has been getting harder and harder for providers, but some are seeing an alternative to hospital-owned practice. By creating ‘grassroots’ networks, independent medical groups, and nontraditional cross-specialty practices, doctors are finding new ways to thrive (and capitalize on the incentives available through the ACO program, MACRA, and the like).

According to the CEO of one innovative healthcare IT company, these entrepreneurial networks are reimagining “the end-to-end consumer experience” in their new models – in part, by “importing best practices from retail, banking, and other consumer-facing industries into their businesses.”

Uncertainty Breeds Innovation

The future of the Affordable Care Act and other healthcare-reform initiatives may be uncertain in today’s political climate, but that’s not stopping forward-thinking entrepreneurs and venture-capital investors from charging forward. In fact, it’s causing them to “double down” on existing initiatives to make them happen no matter what happens... replace, replace, or otherwise.

A recent piece on Fortune noted how the lack of clarity around healthcare policy has brought better focus among innovators: “Rather than chasing Obamacare-related tailwinds and trying to capitalize on different aspects of the current system... the current environment has forced investors and businesses to concentrate more singularly on their product or service.” Here’s hoping their sharpened focus helps all parties in the industry benefit!


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