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Ray de la Pena | October 2, 2019

3 Ways Technology is Improving ED Billing Outcomes

(4 min read) In the current economy of high deductible health plans, patients are feeling the pinch of rising out-of-pocket expenses. In turn, emergency departments are experiencing higher rates of self-pay accounts with longer reimbursement cycles. To protect revenue streams, improve efficiency and circumvent common AR challenges that can hinder timely reimbursement, many practices and billing companies are instituting new processes and technologies to help recover the money owed to them.

a men looking at the phone and money flying out from the phone

One way that billing teams are countering longer reimbursement cycles is by improving the efficiency of front-end processes. This includes the automation of redundant manual tasks that can slow down AR workflows. There are three pre-bill activities that emergency medicine practices and billing companies find most effective and cost-efficient to automate:

  1. Verifying patient demographics
  2. Identifying billable insurance coverage
  3. Determining patient propensity to pay

Patient Data Verification

Incomplete or inaccurate patient data is the primary reason for denied medical claims. Patient data validation tools represent one point of leverage that ED billing teams have to guard against this potential revenue loss. ED billing teams are increasingly using data validation solutions to enhance patient data accuracy and ensure clean claim submissions. That simple process adjustment increases efficiency and reduces the risk of denials, both of which support a healthy bottom line. Patient data validation also improves statement delivery and reduces returned mail volumes. By setting up demographic verification processes on the front-end, before bad data washes downstream to claims, statements and other points of the revenue cycle, practices and billing teams can significantly improve reimbursement outcomes.

Insurance Discovery

ED billing teams are also embracing insurance discovery and verification solutions that equip billing teams with real-time insight into patient benefits and eligibility. Typically, practices and billing companies have to verify patient insurance information by phone or online, which results in a long, manual process. Insurance discovery solutions automate this process, saving time for busy billing teams. Up-front coverage determinations also help billers avoid claims rejections and more effectively manage patient expectations, improving the patient financial experience. Another way insurance discovery benefits patient satisfaction is by helping practices avoid billing patients for balances when eligible insurance is, in fact, available. Insurance discovery solutions explore every available coverage option for the rapidly rising volume of self-pay patients. Uncovering new payor sources can have a dramatic positive impact on revenue for the practice as well as the billing experience for the patient.

Patient Propensity to Pay

With patient payment responsibility at an all-time high, understanding a patient’s propensity to pay the medical expenses they incur is vital. Self-pay analysis solutions help billing teams pre-determine which patients are likely to pay, as well as identify any patients that may qualify for a hardship discount or Medicaid. This knowledge can inform payment arrangements, whereby a patient without insurance but with a high propensity to pay, for example, may be given longer payment terms. These solutions support the diversification of payment options for patients, answering a rising call among consumers for a friendlier, more flexible billing experience. This significantly improves patient satisfaction, which research shows improves patient likelihood to pay their balance in full. With enhanced patient financing options, ED billing teams can reduce the number of accounts outsourced to collections. 

Examination of financial condition Stethoscope on pile of U.S. twenty-dollar bills isolated on white background

Improving Financial Outcomes and Experience

Improving the patient financial experience plays a tremendous role in overall patient satisfaction. ED billing teams’ ability to get patients squared away quickly gives ED patients one less thing to worry about. The right revenue cycle solutions also boost the productivity and confidence of the billing team. By automating key pre-billing processes, emergency department teams can reduce the burden of manual tasks, streamline patient throughput and improve payment discovery. ED billing teams that effectively use technology to augment the billing experience are better positioned to navigate the changing tides of reimbursement today and cater to emerging consumer demands for a more personalized payment experience down the road.

ZOLL’s AR Boost solutions make it easy for billing teams to overcome challenges related to uncovering missing patient information and payment sources. AR Boost automates manual processes by querying multiple databases at once with the click of a button. Insurance discovery solutions use the latest mapping logic for more than 2,000 payors to find active insurance coverage, increasing revenue capture by 10 to 20 percent. These solutions reduce AR workflow times, increase revenue sources and improve the chances of submitting accurate claims on the first pass.  

AR Boost’s self-pay analysis solutions enable ED billing teams to quantify a patient’s propensity to pay so the practice can know which bills to keep in-house. This reduces the number of outstanding patient invoices that are sent to collections by enabling billing departments to focus efforts on the patients who are most likely to pay. It also enhances patient-biller relations and mitigates the risk of a negative patient financial experience that can reflect poorly on provider affiliates.

The rise of high deductible health plans and new self-pay patient populations warrants a new approach to revenue cycle management. ED accounts are managed more effectively by taking fewer and more logical steps to work smarter, not harder. For emergency practices or billing companies dealing with these challenges, the implementation of integrated tools designed to streamline AR workflows is paramount to effectively managing and capturing revenue. By incorporating technology-supported capabilities like patient data verification, insurance discovery and self-pay analysis into front-end billing processes, ED billing teams can ensure that fewer claims are rejected and that the best-fit payment sources are supported.

To learn more about the solutions your billing team can employ to protect and grow your AR revenue, contact ZOLL AR Boost today.

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More About the Author:

Ray de la Pena

Ray has been with ZOLL since 2000 working in various sales and management capacities in the EMS, Hospital, and LifeVest Divisions. He has a bachelor’s degree in chemistry from the University of Kansas and an MBA in Finance from the University of Missouri-Kansas City. Ray’s hobbies include spending time with his wife and two boys, following Kansas City and University of Kansas sports, playing golf, and enjoying any time spent outdoors.