Posted By Abhi Muthiyan On June 25, 2014

They’re Going Around: Local Health Department Billing Headaches

State and federal budgets are shrinking. The cost of providing clinical services is steadily increasing. Billing software 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.

Issues related to billing are some of the most frustrating and time-consuming issues a local health department (LHD) will face. Ultimately, LHDs are responsible for the healthcare of their communities, and as such, have been an integral part of the changes brought about by the Affordable Care Act. And while an increase in the availability of insurance is helpful, gaps and inconsistencies will continue to exist.

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. There are intricacies associated with billing to each, and each LHD has its own unique methods of operation as well. To add to that, billing professionals have to navigate a number of disjointed systems in order to gather patient data and determine where to send the bill in the first place. Incorrect reporting by the patient or simple human error on the part of billing professionals can lead to reimbursement denials from Medicaid and Medicare, which often leads to round after round of resubmissions and delayed funding.

It’s critical to alleviate these issues, and soon. Better billing processes mean more resources for local health departments, which mean greater investments and improvements in patient care. So what needs to happen?

One tool that will go a long way in promoting change is an integrated electronic health record (EHR) system. 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 EHR:

What’s best for billing?

  • Unfortunately, many older, legacy EHR systems require the management of third party billing via a clearinghouse user portal. But because the portal is outside of the legacy system, users have to access a completely different software application for third party claims management.
    • Solution: Look for a system that integrates seamlessly with the clearinghouse so you can manage your claim information from just one system.
  • The above also holds true when it comes to patient eligibility verification, which is typically performed on the agency’s clearinghouse user portal (again creating the need for a second system for eligibility verification).
    • Solution: Again, look for a comprehensive system that allows eligibility verification to occur at the time of keying the patient’s insurance. Not only should you not have to leave the system, but a good program will allow you to access this step quickly and easily, without a lot of jumping around. The faster you can accurately process these claims, the faster your agency can be paid.
  • In many legacy systems, billing claims electronically requires a user to complete multiple steps. In many cases, a billing batch file is created. Then, users generate a report to see if there are any errors found within the batch of claims before pushing the claims out of the system.
    • Solution: There are a couple of catches here—first, not all systems provide detailed error checks. And some that do only look for specific fields that are missing data, NOT items that may result in denials. Look for an intelligent system that can streamline and automate the billing process. It should catch or eliminate data entry problems early on. For example, it could ensure that demographics are entered in only one place and automatically flow to other parts of the EHR, thus eliminating erroneous data entry errors. Also, a claim scrubber technology can ensure that the claims being sent to payers are in accordance with the requirements set by each respective insurance provider. This will radically cut down on the number of denials.
  • Legacy systems that submit large batches (i.e., many claims in one batch) to a payer can experience multiple rejections at one time due to a single claim that contains invalid data. This results in users having to spend a greater amount of time re-billing claims.
    • Solution: Choose software that keeps batch sizes small so as to minimize any negative impacts that could be caused by rejected claims. Ideally, only the claims with errors will come back—while the others are processed to the payer for adjudication.
  • Sometimes tackling re-bills is a complex process. In many cases, a user flags a claim for re-bill and then this flagged claim is included in a future billing batch file that is sent out of the system. But, this results in delays for denied claims being resubmitted to the payer. And, the process to mark a claim for re-bill often involves multiple steps.
    • 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 make the adjustment on that particular claim and then re-submit it immediately so that it doesn’t linger on your to-do list.
  • Old legacy systems require a complex approach to managing payers. Users often have to keep and maintain multiple payers for a client in order to maintain billing history. The process of keying the values needed by payers over and over again is time-consuming and increases the chances of data entry 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.
  • Many systems don’t offer a good aging accounts receivable report, a crucial management tool that allows billing professionals to see how long an invoice has been outstanding. This not only provides info on the financial health of your clients, it reflects the health of your organization too.
    • Solution: Be sure that the EHR you choose offers an easy, clear-cut way of generating this report on a regular basis. Having better financial data means arming leadership with the information it needs to make smarter decisions on behalf of the organization and the population it represents.

A comprehensive, integrated EHR 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. An intelligent, flexible and well-connected EHR is an asset to the billing practices of any department—and also to the larger organization as well.

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