How to reduce surprise billing in your practice?
Every other service comes with a service charge. So, whether it is the food and beverage service that we get at a restaurant or healthcare services that we are offered at healthcare practices and medical units, we should pay the charge accrued. The billing process is what defines these charges and presents them in a comprehensive yet consolidated way.
The billing process that is proceeded with at the healthcare practices is often termed medical billing, due to the billing processâ association with the medical industry. Medical bills are bills that contain all the details of everything associated with the healthcare service including medical products, consultation fees, and other service charges, and their rates. However, along with normal medical billings that are done, the patients often complain of surprise medical billings that they were unknown of. Now, if you are thinking about surprise billing and what it is, then the next section will inform you all about that.
What are surprise medical bills and billings?
Surprise medical bills are unexpected bills that come from a healthcare provider or facility. Surprise billing occurs in healthcare when the patients find extra charges added to their bills because the clinicians were not in the network of the insurance plan of the patient.
For example, letâs assume a patient needs medical care and assistance. In most such cases, they usually search for a medical care unit that has a tie-up with their insurance providers. However, on some occasions, the patients end up choosing providers who are not in their network, and who are out-of-network providers. This is one occasion when the patients can get surprise bills.
The patients can find surprise medical billing issues in another way. This is if the patients select an in-network healthcare provider, which by any chance, needs to allot doctors or physicians, who donât happen to be in the same network as the patients. Even in this case, though the patients would not be entirely surprised, they will definitely find issues with these surprise billing bills, which they thought, would be within their network.
What is the surprise in the surprise medical billing?
The medical billing that happens to be unexpected is often termed surprise medical billing. This surprise peculiarly occurs to the patients or their billpayers, when they select a hospital or a practice that is within their network but still finds charges to be paid. The charges that particularly reflect on the surprise medical bills are usually the balance that the patients need to pay, which is the difference between the amount that the healthcare provider charges and the sum that their insurance provider would pay.
Though surprise billing might seem something new and interesting for many, these bills are pure woes for the patients who get them, and in the situations when they get them. Besides, surprise billing is also not very uncommon either. Around 1 in every five patients rushing down for emergency care receives surprise medical bills, associated with the out-of-network care or care provider.
We seem to be always complaining about the rising healthcare costs. However, we should also know that this rise in the costs of healthcare is partly also related to the surprise bills and billing practices by medical units and practices. Studies estimate that the surprise medical bills exceed the cost of specialty physician care for employer-sponsored health insurance by over 3.4%, which is nearly $40 bn.
Main Causes of Surprise Billings!
Surprise billings can happen due to many reasons. Some of the most prominent reasons why the patients today see an increase in surprise medical billings are discussed below:
Clever contracts by the insurance providers
The insurance providers of today are known for their dextrously made, brain-twisting consent forms, rules, and regulations that the patient needs to sign before the doctor's visit. Such bills, forms, and rules and regulations contain the services that they will provide for and all those which will have to be paid out of pocket. Here the insurance providers had to sit for long discussions to get approval from the healthcare practice and other medical units before they negotiate and declare that they would offer discounted rates for some services ad doctor consultations, while everything else would be chargeable.
Certain specialties are out-of-network for the patients
There are many specialties in the healthcare industry and in the practices that always operate as out-of-network care services. Such services which do not come under the insurance providers' network are pathology, radiology, anesthesiology, emergency medicine, and more. If the patients opt for such services or need them, then they would certainly see surprise billing.
Private programs
Surprise billing might sound to be a real issue for practices but if we look at the government-sponsored programs, then you would be shocked to discover that no surprise billing issues need to be faced. Government-sponsored programs like Medicaid, Medicare, and veteran's care do not usually accrue surprise bills simply because they pay fixed fees to the providers.
Billing errors
Billing errors are among the most common woes for the patients and practices. Going by the statistics, over 80% of all medical bills contain errors. These billing errors might also result in surprise billing issues. However, such billing errors can now be avoided by the practices if they opt for the cutting-edge billing software and systems that the trustworthy medical office software providers like GrowPractice provide them with.
Claim errors
As we have previously mentioned about the bills, it is also not so shocking to find out medical claims with errors. This is because research reveals that around 50% of medical claims are also spiked with errors. To speak plainly there's absolutely a 50-50 chance that you will find a medical claim with mistakes. Dissolving such mistakes would not only save the patients from bearing unnecessary costs but also help the practices prosper by boosting their credibility and reputation.
Frauds in billing
Medical bills are mostly quite erroneous. However, it is also true that there are medical billing frauds too. Yes, phony charging can occur due to these instances according to the National Health Care Anti-Fraud Association and billing experts:
• Services listed in the bills are often not provided to the patients at all.
• Intentional double-billing is done by the providers to increase the charges and double their revenue.
• Some providers even use upcoding while billing the patients. Here, they often charge the patients for a more expensive service that wasn't performed even for them.
• Patients are often billed separately for each of the services instead of adding them in a consolidated way, which is usually the format.
• Patients often find the amount more than the copay amount. This is also sometimes done intentionally.
Surprise medical billing and bill legislation!
Surprise medical billing is a global problem and not confined to a particular region in any single country. To avoid this surprise medical billing problem, legislation is needed, as indicated by a remarkable bipartisan consensus. Though the earlier initiatives were deemed weak, the spur after the Covid-19 for the eradication of surprise billing is remarkable indeed. However, the fight against surprise medical billing issues will still be dragged a long way indeed. Nonetheless, there is certainly something that can somehow prevent today's patients' from the adverse impacts of surprise medical billing.
Easy ways to contain surprise medical billing at your practice!
Surprise billing is common, but where do these bills spring from? Yes, from the medical practices indeed, which is why the healthcare practices need to be aware of medical billing and would reduce the same at any cost. Besides, it would work even better if they together support surprise medical bill legislation. Therefore, without further ado, let's dive into the easy ways to reduce surprise medical billing issues at practices:
Stay transparent from beforehand
Over 65% of the patients want to have transparent services while in a medical practice or healthcare unit. Around 77% of the patients' state unpredictability of the healthcare costs. Here, all they want is transparency, which can easily be embraced by healthcare practices. Today, the healthcare practice can avail of innovative medical office software solutions from GrowPractice via which calculating the costs after the review is prompt and error-free. This will enable the practices to quote the charges to the patients right at the beginning.
Automatize the medical office
Digital is the age that demands the practices to be digital. More and more patients are going online each day either to research health and care, medicines, book appointments, check their medical records, and more. All of these are now possible with GrowPractice's trustworthy patient and practice management system and software. Among such things, the billing process can also be easily automatized to improve the accuracy of billing and raise the provider to the standards that can only be dreamed of today.
Hire smart staff
While in the healthcare industry, around 18% of the workforce resigned since the Covid-19 outbreak, hiring smart staff has taken a downturn. This will lead to practices witnessing more harm than good. Here, hiring smart staff might help them indeed.
Review the services quickly before proceeding
The services received by the patients need to be reviewed as a whole by the healthcare providers to avoid any wrong billing or double-billing. One such check of quality would certainly help the practices minimize the surprise billing issues of the patients.
Avoid stress and burnout for medical workers
The most common reason for mistakes in medical bills and billing processes is the burnout that the medical staff often go through. Though these burnouts have already started to improve drastically with the emergence of digital patient and practice management software and solutions, they have not been ended to date. However, the coming days would certainly see an end to them, thereby reducing the surprise billing issues.
GrowPractice will further improve the handling of surprise billings!
If you are further looking to reduce the surprise medical bills and billings, then it is GrowPractice that you can thank. The trustworthy provider of medical office, practice management, and patient management software and solutions that GrowPractice brings to the practices, help them grow by subsiding surprise medical billings and more. The advanced automatic billing software that GrowPractice offers practices helps them to automatize medical patient payments and offers them flexible payment options to receive collections securely. Safeguarded by the HIPAA guidelines, multi-level authentication, and robust data encryption, GrowPractice is just the solution for the surprise billing issues that you want. So, contact GrowPractice now for more information and updates about their service and to avail them!
