Posted By Denton Dickerson On March 28, 2024
They’re Going Around: Local Health Department Billing Headaches
State and federal budgets are shrinking while the cost of providing clinical services is steadily increasing. The billing software at many Local Health Departments across the US is antiquated. Patient data is located in multiple software systems and on paper. It’s impossible to create reports or get access to accurate data. Errors and inconsistencies continue to surface.
Billing problems are some of the most frustrating and time-consuming issues a local health department (LHD) will face.
Billing third-party payers allows LHDs to provide services to a patient regardless of his or her insurance status. But what this means is that the department must now keep track of its Medicare, Medicaid, and private insurance billing streams—and that’s not simple. Each LHD has its unique methods of operation as well. Additionally, billing professionals have to navigate several disjointed systems to gather patient data and determine where to send the bill in the first place. Incorrect reporting by the patient or errors made by billing professionals can cause reimbursement denials, multiple resubmissions, and delayed funding.
Better billing processes mean more resources for local health departments, which means greater investments and improvements in patient care. So what needs to happen?
Billing Problems and Solutions
One tool that will go a long way in promoting change is an integrated electronic health record (EHR), Practice Management, and Billing solution designed for public health. A good system should serve as a hub to provide your health department with connections to various public health programs. It should be tailored to your organization so that it accurately aligns with your unique billing workflows. Below we’ve outlined some potential pitfalls to avoid—and some solutions to pursue—when it comes to looking at the billing features of an integrated EHR:
- Problem: Older EHR systems often require a separate software application for third-party billing management due to their reliance on an external clearinghouse user portal.
- Solution: Look for a system that integrates seamlessly with the clearinghouse so you can manage your claim information from just one system.
- Problem: Patient eligibility verification often requires third-party applications on many less-capable EHRs.
- Solution: Seek a comprehensive billing system that enables quick and easy eligibility verification during patient checking, speeding up accurate claim processing and accelerating agency payments.
- Problem: Finding billing claims errors requires multiple steps including user-generated reports based on billing batch files.
- Solution: Opt for an intelligent EHR billing system that not only automates and streamlines the process but also provides thorough error checks and claim scrubber technology to prevent denials by ensuring data accuracy and compliance with each insurance provider’s requirements.
- Problem: Legacy systems often require you to submit large batches. This can result in multiple rejections at once due to a single claim that contains invalid data.
- Solution: Choose software that keeps batch sizes small to minimize the time spent re-billing claims. Ideally, only the claims with errors will come back—while the others are processed to the payer for adjudication.
- Problem: Tackling re-bills is often a complex process involving multiple steps to flag a claim. This can result in delayed resubmission of denied claims to the payer.
- Solution: The process doesn’t have to be so complicated, so look for a system that keeps it simple. Ideally, if a claim is denied, you can simply adjust that particular claim and then re-submit it immediately so that it doesn’t linger on your to-do list.
- Problem: Managing payers in an outdated EHR system is complex and time-consuming, requiring users to maintain multiple client accounts and repeatedly input data, increasing the risk of errors.
- Solution: Find a software system that allows you to maintain an active list of payers for the client, and is designed so that your re-bills will still pull the payer that was associated with the client at the time of service. Keep your payer list short and manageable. There’s no need to track 10 different payers for each patient just so you can maintain an accurate billing history.
- Problem: Some EHRs lack a comprehensive aging accounts receivable report. This report tracks how long invoices have been outstanding and is crucial for evaluating the financial health of your healthcare organization.
- Solution: Be sure that the EHR you choose offers an easy, clear-cut way of generating this and other reports regularly. Having better financial data arms leadership with the information it needs to make smarter decisions on behalf of your organization.
A comprehensive, integrated EHR, Practice Management, and Billing solution isn’t the only thing LHDs need to be successful, but it is a critical component to delivering better patient care and alleviating serious employee headaches and organizational inefficiencies.
For tips on selecting an EHR, check out our blog on improving our collections process.
For more on local health department billing, watch our webinar on billing best practices.
Originally posted by Abhi Muthiyan