Eliminate Billing Errors with AI-Powered CDI & Revenue Integrity Solution

By: exdionrcm

Pitfalls in Managing Billing Errors

Pitfalls in Managing Billing Errors at Acute Care Centers and How to Maneuver them?

Revenue management is one of the most essential business operational activities and a healthcare business is certainly not an exception. It is impossible to find a healthcare provider that has never encountered unprecedented complexities with regards to billing and coding processes. 

Most of the healthcare providers – be it Family Medicine, Acute Care Centers or any other category – are subjected to a chunk of complicated patient and prescription data, not to mention billing and revenue information. The recent pandemic situation has further accelerated the situation. The tremendous increase in providing medical care and huge influx of patients have certainly made revenue management a herculean task. Under these circumstances, even a small overbilling or underbilling issue can have a tremendous toll on revenue generation. 

However, the distorted work process coupled with legacy infrastructure has made billing errors a common problem. The solution is, revolutionizing the entire revenue management cycle to eliminate all types of billing errors. 

Let’s discuss the common errors in healthcare billing:

  1. Units Billed vs Dosage Administered

This is one of the most common billing errors. There is no denying the fact that accurate medication coding is one of the most essential components of the Healthcare Coding System. 

In an ideal scenario, when a drug administration claim is submitted then the units billed should match with the dosage prescribed as well as the volume administered by the patient. 

Any sort of discrepancy can cause over and under billing issues. Manual coding is susceptible to this kind of error especially during times like this, where there is mammoth pressure.

2. Improper Documentation of Patient Information

Medical billing process starts from the first point of contact between patient and the healthcare organization. It begins with the frontline staff collecting patient information and laying the foundation for collection. 

From the perspective of the revenue cycle, it is of utmost importance to get all the important information up front and complete the patient registration. This basically does the groundwork for future operations. 

It might sound simple but enormous amounts of data and a strict deadline can often result in improper or incomplete documentation of patient information. Any errors in the initial stage can mushroom when it comes to bill reimbursements. Errors like this do not often show up in basic reconciliations. This is why proper documentation is so important. Manual documentation is always prone to this category of errors. 

Getting patient information up front presented in a streamlined manner saves a lot of time and helps in delivering a brilliant customer experience.

3. Lack of Follow-ups

Following-up on a patient’s financial responsibility is a must. More often than not, coders dealing with bill payments and processing have to encounter enormous troubles due to inefficient procedures. 

We need to understand that even if the billing process is error-free, a continuous follow-up is always required. Both care providers and patients need real-time notifications and updates. As a result it causes a delay in action, resulting in delayed claim processing and increased patient dissatisfaction. 

Providing timely alerts and follow-ups manually on a consistent basis is certainly a difficult mission to accomplish

4. Manual Claims Management

Claims management is a vast and complex process with a multitude of factors. Healthcare providers must have the right data at their disposal and there must be a seamless communication between the frontend and backend staff. 

Leave alone, checking and reimbursements, claims management is an extremely labor-intensive process. It requires a lot of time.

Added to that, it has multiple stages and even a small mistake in any of the stages can adversely affect the overall service quality rendered by the healthcare provider. There is a lot of dependency on too many people and so achieving maximum accuracy is a daunting task.

How to Overcome Those Challenges?

Transformation is the best solution. Over the years, the healthcare sector has been run by legacy infrastructure. The current pandemic-hit situation has certainly been an eye-opener. Healthcare providers are now adopting state-of-the-art technologies to automate their billing process. Automation reduces revenue mismanagement by removing manual errors. It saves a lot of time and frees healthcare professionals from tedious and monotonous works. This time can be better utilized in catering to more critical services and patient requirements.

ExdionCA: The Ultimate Healthcare Billing Solution

ExdionCA is an automated Revenue Integrity solution powered by Artificial Intelligence and Deep Learning. It helps to streamline the Coding & Charge Entry process thereby ensuring maximum billing efficiency. 

Below are the benefits of adopting ExdionCA: 

  1. Increased Revenue Integrity 
  2. Achieve maximum Accuracy 
  3. Eliminates manual errors 
  4. Saves time 
  5. Reduces administration expenses
  6. Streamlines claim management process. 

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