How Better Billing Workflows Can Help Michigan OB/GYN Practices Focus More on Patients

By Your Health Magazine Contributor

Your Health Magazine Contributor

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How Better Billing Workflows Can Help Michigan OB/GYN Practices Focus More on Patients

Patient experience doesn’t start at the examination room for OB/GYN practices. It starts with making the appointment, verifying insurance information, answering questions, providing paperwork, etc., and the administrative aspects surrounding care.

As patient numbers continue to rise, it can become more difficult to run a Michigan OB/GYN practice efficiently. Organized billing and administrative processes allow staff to spend less time chasing down unpaid bills, reconciling insurance information, chasing down avoidable issues, and correcting claims.

All that administrative work can distract from patient care.

A well-designed billing process can help practices avoid needless hassle, guarantee financial uniformity, and provide staff more time to provide quality patient care.

The Growing Administrative Pressure on OB/GYN Practices

OB/GYN practices offer a variety of services, such as routine exams, preventive care, prenatal visits, procedures, delivery, and postpartum visits.

The documentation, coding, insurance and billing needs for each service may be different. The more patients that go through the system, the more administrative tasks there are to go with those patients.

A lack of a work flow can snowball small issues into big issues.

A clerical error in the insurance information could cause a delay in the claim. The rejection can be caused by incomplete information. If a denial is not resolved, it can sit in accounts receivable for months and months. In the meantime, employees in the office may need to dedicate more time to answering billing queries or rectifying administrative issues.

The outcome is an administrative process that can be hard to manage.

Better Billing Starts Before the Claim

A good way to enhance the revenue cycle is to solve any issues before they reach the claims stage.

One such example is benefits and eligibility verification. Checking in with a patient’s insurance before an appointment can determine if there are any factors that could be a problem with the coverage or if the patient has benefits that need to be utilized, or if the insurance information is outdated.

It is particularly useful for OB/GYN practices since patients may have different coverage considerations throughout their pregnancy, delivery, postpartum period, among other parts of their treatment.

The regular verification process allows staff to address queries early to avoid uncovering problems and challenges after services have been delivered.

Accurate Claims Can Reduce Administrative Rework

If the claim is submitted incorrectly, it could take extra staff time to make the claim to receive payment.

Rejected or denied claims are caused by coding problems, missing information, patient misinformation, and other issues. Staff will then need to probe the topic, correct the claim to resubmit, and track its development.

This generates work which may have been avoided at the start of the billing cycle through the use of better processes.

If your practice is looking to beef up its revenue cycle, you can get support from specialized Michigan OB/GYN medical billing services that can cater to the administrative and billing needs of your practice, which require a different approach.

It’s not just about turning in claims quickly. Its purpose is to develop a more precise and uniform method with minimal interruptions.

Denial Management Should Be Proactive

The denial of claims can easily become a burden to administration.

Without claims denied, staff can devote hours to following up with payers to determine the reason for the denial, correct the information, appeal, and follow up on unpaid claims.

A proactive denial-management process is more than simply looking at each claim. It looks at if the same issues are occurring over and over.

If a practice routinely sees denials for eligibility, for instance, then it may be beneficial to look at the verification process. The practice could review the preparation of claims if there are services that continue to create coding problems.

Pattern recognition can be useful in helping practices to solve the problem instead of making the same problem over and over.

A/R Management Can Protect Staff Time

Another resource sucking department is accounts receivable.

There is an ongoing need to deal with unpaid insurance claims and patient balances. Older accounts may need to be more deeply researched and followed-up.

An organized approach to A/R can assist practices in prioritizing unpaid bills, keeping track of aging bills, and ensuring that bills are followed up on in a consistent manner.

This can help to establish a more streamlined billing process. Staff do not need to keep constantly switch to the next account to see what needs their attention, but with an organized system, they can work on accounts by age, balance, payer, and status.

An improved A/R process can also help practice leaders see outstanding revenue and see where the money is going in their practice.

Better Billing Can Improve the Patient Experience

Patients are still affected by the consequences of the billing, but it often occurs out of their awareness.

When a patient receives bills they didn’t expect, insurance questions are not answered, or it’s difficult for the patient to respond to financial inquiries, he or she can get frustrated.

Some of this gathering can be mitigated by tidying up administrative procedures.

If claims are properly processed and billing questions addressed in the same manner, patients can be better informed about their financial obligations when information is verified.

For an OB/GYN practice, it’s important because patients may be in important and at times stressful parts of their healthcare journey. There should not be any more uncertainty due to avoidable administrative mishaps.

Outsourcing Can Give Growing Practices More Flexibility

Every OB/GYN practice doesn’t have the in-house means and resources to work all aspects of the revenue cycle efficiently.

For a growing practice, it may not always be the best idea to add more administrative personnel. There is another alternative with specialized outside help.

Professional medical billing services can help practices with many aspects of medical billing, including eligibility verification, claims processing, denial management, payment posting and A/R follow-up.

The answer to this question will vary based on the size of the practice, the specialty, the number of patients seen, the resources in-house and the practice’s goals. But, by outsourcing specific revenue-cycle tasks, in-house teams can focus more on patient-related tasks.

Technology Is Only Part of the Solution

Technologies can improve billing work flow. Some manual tasks can be automated with electronic eligibility verification and automated claim submission, reporting tools, and practice-management systems.

However, technology is not the answer to an inefficient process.

Clear responsibilities, appropriate training, quality control and follow-up procedures for staff remain. There must also be someone to analyze and resolve exceptions, and to decide on how unusual or complex issues are to be resolved.

The best billing flows are typically the ones that have the right technology, the right people and well-defined processes.

Creating a More Patient-Focused Practice

The focus doesn’t shift when it comes to patient care when it comes to improving billing. The reverse side of the coin is the case in many situations.

Efficient administrative processes allow staff to spend less time on preventable problems and more care and attention with providers and patients.

That can mean for Michigan OB/GYN practices:

• Fewer avoidable billing interruptions
• Improved insurance verification
• Better claim follow-up
• Greater visibility into outstanding revenue
• Reduced administrative pressure
• Clearer patient communication

The enhancements can establish a better operational base for the ongoing expansion of the practice.

Conclusion

Behind the scenes in healthcare matters is the administration that doesn’t necessarily get noticed by the patient, but it is still important to the healthcare experience.

Inefficient billing processes can keep Michigan OB/GYN practices from getting paid on time, drive up the administrative burden and cause unnecessary friction on the part of the patient. A more systematic approach may be useful to these issues before they can be bigger problems.

Every revenue cycle step from insurance verification and accurate claims, to denial management and A/R follow-up is an opportunity to be more efficient.

Finally, it’s not simply about revenue collection when it comes to billing. It’s about building a better operating system for staff that will allow them to be more productive and for providers to take the time to concentrate on what’s important—their patient.