It is estimated that between 49% to 80% medical bills suffer from at least one error. These errors could end-up creating problems such as denial or rejected claims during settlement leading to revenue losses to a healthcare provider.
There can be reasons such as inadequate training and lack of experience that could lead to this problem. Although adding to it, reasons such as human error, incorrect medical code, incorrect data, posting errors, etc. are frequently witnessed.
At one end where healthcare providers are constantly hustling to provide the best care to the patients, there are issues that are creating losses for them. It is important to talk about this because without revenue generation, no service can stay operational. In this situation, an Intelligent Document Processing platform such as VisionERA can provide the necessary medical billing and coding automation. It can process all the unstructured data produced by a healthcare organization with minimal intervention without making errors.
Yet before talking about VisionERA IDP, it is better to talk about what medical billing and coding is? What is the anatomy of a bill? and the process associated with medical billing, therefore, read ahead...
What is Medical Billing?
Medical payments especially in developed nations like the U.S. are carried via insurances through claims settlement. Medical billing is the process of settling healthcare claims from an insurance company. The healthcare organizations receive the due payment rendered after providing necessary healthcare services. In order to do so, the medical billers translate the medical services provided into medical bills for reimbursement from the insurance company. This work of translation can be effectively accelerated using VisionERA. It will allow the user to extract data from various sources and help them collate into a single medical bill.
Relevance of Medical Coding for Medical Billing Process
Medical coding is an essential part of the medical billing process. Medical codes are alphanumeric representations of medical procedures, diagnosis, service, and equipment. A medical coder with the help of medical charts translates the services rendered by a patient into medical codes. These medical codes are used in medical bills for healthcare claims settlement purposes.
Below are the types of different charts utilized by medical coders:
- International Classification of Diseases (ICD)
- Current Procedure Terminology (CPT)
- Health Care Procedural Coding System (HCPCS)
- Code on Dental Procedures and Nomenclature (CDT)
- Ambulatory Payment Categories (APC)
- National Drugs Code (NDC)
- Medical Severity Diagnosis Related Groups (MS-DRG)
Anatomy of a Medical Bill
A medical bill comprises multiple entries that are extracted for recording and maintenance purposes. These are:
- Patient Name: As the entry suggests, it is the name of the patient.
- Account Number: It is a unique number assigned to a patient upon its admission to the hospital or healthcare organization.
- Services From: It is the date of admission of the patient.
- Service To: It is the date of release of the patient.
- Statement Date: It is the date that the doctor or the hospital prints the medical bill.
- Department: These are the different departments that were involved during the treatment for example radiology, pharmacy, observation, anesthesia, physicians, etc.
- Date: It signifies the date on which the patient received aid from a particular department.
- Description: It is the type of service rendered by the patient from different departments of the healthcare organization. Medical codes are mentioned in this column only to signify different treatments.
- Charge: It is the base price of the service rendered a single time.
- Quantity: It is the number of times a service is rendered by the patient.
- Total: It is the multiplication of charge and quantity prior to the services rendered.
- Total Charges: It is the sum total of the all services rendered by a patient during the treatment.
Each of these entries are recorded and maintained within a healthcare organization to tackle issues related to claims denial or rejection in the future. This work of extracting data can be time consuming once everything needs to be consolidated for creating ledgers and creating reports for mitigating revenue leakages. Here also, VisionERA could be relied on as a dependable platform for effectively creating ledgers and reports without any errors.
Medical Billing Process in a Healthcare Organization
There are multiple steps that take place in order to complete a single cycle for a patient for medical billing. These are:
Insurance Eligibility Verification: The step includes the verification of the coverage of the patient being administered. In order to do so, the medical biller will confirm the active coverage of the admitted patient from the insurance company.
Patient Demographics Entry: It is the entry of basic information related to the patient in the health insurance claim. It includes entries such as the patient's name, address, contact, age, social security number, etc.
Medical Coding: During this step, a medical coder will translate the different types of treatments & services administered to a patient into standardized medical codes.
Charge Posting: At this step, a medical biller will collect or post a claim to the concerned party that can be settled timely. It also includes radiology and eye-care procedures.
Claims Submission, Electronic Billing, & Paper Billing: This step revolves around submitting the claims made and creation of electronic and paper-based bills.
Payment Posting: It is the step during which the issues related to the payer are identified. These issues can include non-covered services, denial of medical necessity, prior authorization, etc. Once identified, these issues are transferred to the team to mitigate.
A/R Followup Denial Management & Appeals: A/R stands for accounts receivable. It is similar to accounts payable. Although in healthcare, A/R follows up with the insurance company for the denials of payment accrued by the healthcare organization for a patient. In case of denials, the A/R team appeals for claims settlement after necessary auditing and clearance of the issues at hand.
Patient Statements: It is a step where a statement for the patient is created. This statement provides necessary information such as the amount approved by the insurance company, contractual adjustments, and the amount of payment due on the patient itself.
Reporting: It is the step at which a detailed report related to a patient is created. These reports contain useful insights and KPIs for the healthcare organization to improve patient outcomes and maintain ledger for revenue accrued for reducing unnecessary costs.
Patient Scheduling: It is the scheduling of the patient’s appointment for providing the treatment within the hospital care facilities.
Each of these steps are intertwined and dependent on each other that requires data extraction and verification at some level. The time spent on medical billing and coding can be a lot keeping manual processing into perspective. Also, it could end-up adding multiple human-induced errors that can hinder the process of medical billing and settling claims with ease.
On the other hand with medical billing and coding automation using VisionERA, it is possible to drastically reduce the TAT (turnaround time) and cost associated with the process. Also, the automation of these processes will aid in removal of any redundancies while avoiding errors in the data with minimal intervention.
Importance of Collecting Data from Medical Bills
There is a consistent gap between the healthcare services rendered and the payment received. Oftentimes, the patient would be admitted to the hospital, receive its treatment, and be discharged but the payment still remains due from the insurer's side. To have a consistent report so that medical billers can reach out to the insurance company for relevant debt clearance, these records are maintained within the organization. With VisionERA, it would be possible to process these requirements and submit claims faster to the insurance company.
VisionERA- Platform for Medical Billing Automation for Healthcare
It is estimated that every denial for claims settlement can cost between $25 to $45 for rebilling and collection. In situations such as this, VisionERA can serve as a one-stop solution that not only extracts data with minimal intervention, makes zero-error, but also reduces time and cost of unstructured document processing operations exponentially.
VisionERA allows its user to create custom DIY workflow and documentation making it an ideal solution for multiple use cases including medical billing and coding automation.
Adding to it, VisionERA takes advantage of multiple advanced proprietary technologies such as Artificial Intelligence (AI), Natural Language Processing (NLP), and Computer Vision. It can seamlessly integrate with any organization's existing infrastructure via downstream applications such as ERP, SAP, DMS, mails, messages, etc.
Aside from it, VisionERA offers compelling features such as contextual autocorrection, industry beating table detection system, processing scanned handwritten documents, etc. Also, the platform has a smart insights board that provides useful KPIs for any organization to work with.
Medical billing is an essential part of any healthcare organization. It allows them to keep operational by tracking claims, reporting of costs, auditing of revenue & expenditure, etc. With age-old traditional practices such as manual data entry and OCRs, the process is cost-intensive, time consuming, and incapable of processing unstructured documents. IDP platforms such as VisionERA creates required medical billing and coding automation that cuts down the unnecessary cycle time for each transaction. It frees the medical billers and coders from liabilities such as error-prone data, duplicate data, repeat data, etc. It reduces redundancies in the process and makes the revenue structure of a healthcare organization well organized and optimized.
To read our case study on how VisionERA helped automate medical coding for an organization, click on the link here.
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