Streamlining billing with IT to increase hospital revenue

Technology can notice oversights and help with formatting. And artificial intelligence has a role to play.
By Benjamin Harris
01:45 AM
Streamlining billing with IT to increase hospital revenue

The labyrinths of billing can be navigated much more successfully when proper technology is deployed, simplifying everything from how to format a patient’s name to catching overlooked items not on the bill.

Deploying IT to help streamline and simplify the billing process gives hospitals a much-needed edge during the crucial billing timeframe.

WHAT HAPPENED

Dan Ward, vice president of growth enablement at healthcare revenue cycle management technology and services vendor Waystar, talks about some ways that providers can leverage IT to streamline and improve their billing process.

By providing automatic shortcuts, delivering more accurate information on a patient, and even predicting the orders of physicians, there are numerous IT solutions that can help make the billing process more seamless.

WHY IT MATTERS

Knowing what a payer is most likely to cover and how they like to see those charges can go a long way toward a successful claim and prompt payment. Using that information to construct a bill properly the first time around can help to not “waste time during the precious billing window,” Ward advised.

For instance, “if we know a patient is coming into the cath lab and we know [the insurer] pays on these billing codes, let’s prepopulate the bill with that information,” he said. Effectively, it’s a “cheat sheet” that knows how to call for reimbursement properly.

Even a bill that has the right charges, the most favorable procedures and great documentation can be rejected automatically because of a simple formatting error. Even putting a patient’s date of birth before their name when a payer wants it the other way around can stall reimbursement.

“A well-run, efficient hospital will take advantage of technology that knows how to position data,” Ward contended.

THE LARGER TREND
Artificial intelligence and machine learning now are available to hospitals to help with billing matters. These technologies are trending in healthcare, and can definitely help in the billing department.

“We have to hope everything that was done was appropriately charged for and done in the way the payer expects to see them,” Ward continued. “There’s a lot of standardization, but a lot of difference the ways one insurer likes to see it versus another.”

Because of this, hospitals can employ “cutting-edge machine learning to ascertain every time [a doctor performs a procedure] with this type of anesthesia, this type of sheath, this [additional] thing would be done, but I don’t see it on this billing,” Ward explained. The AI can then help make a correction. Machine learning assistance looking over a bill helps “make sure all the raw materials you need to make a bill are there,” he said.

“It’s up to the hospital to be its own watchdog on billing and reimbursement checking,” Ward said.

Benjamin Harris is a Maine-based freelance writer and former new media producer for HIMSS Media.
Twitter: @BenzoHarris.