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How to Simplify Payer Communication and Ease Your Billing Process

September 21, 2023
Woman communicating with payer

Billing is a necessary part of the healthcare revenue cycle. All medical billing information must be correct. This will help to avoid underpayment and keep medical practices running within budget. Mistakes and miscommunication cause issues and frustration for the healthcare payer and the office staff. Clearly, explaining healthcare billing can expedite the process, leaving everyone satisfied. It sounds so simple — shouldn’t it always work this way?

In an ideal world, it would. However, coding issues, clerical errors, and insurance claims prevent the process from going smoothly. Let’s look at common challenges faced in payer communication and billing processes. We’ll also cover best practices that can lead to better communication and better outcomes.

Overview of EDI Solutions for Healthcare Payer Communication

Electronic Data Interchange, (EDI) solutions assist healthcare payer communication between providers and payers. Its automated services have replaced the need for paper exchanges such as fax and email. It’s a universal document management method that reduces human error and improves processing time. The types of data being exchanged electronically include: 

Insurance claims

This includes claim status and processing of the claim. It provides eligibility information so the patient understands what is and is not covered by their insurance provider.

Billing details

Billing details include payment data such as how much is owed and the due date for payment. It will include itemizations so the patient can understand what is being billed and by which provider. 

There are many advantages of using EDI solutions for payer communication, with the biggest advantage being security. Healthcare-related documents are exchanged through a secure system. They can only be accessed by authorized individuals. Exchanging documents securely in a globally accepted format makes the process easier for all parties.

Other benefits include reduced errors. These systems can typically flag errors before sharing a document and allow you to fix them. Automated EDI solutions also greatly reduce processing time to a matter of minutes. This is much quicker than the hours it would take to process multiple documents manually. This also reduces expenses; with the ease of automation, employees can spend less time on billing and more time on other aspects of their work.

Implementing Patient Data Management Software to Ease the Billing Process

Let’s face it: healthcare involves a lot of paperwork. With systems turning digital, this documentation now involves managing patient data through a software management system. Patient data management software includes many helpful features, such as scheduling and billing. These keep patient information organized and secure.

This software keeps track of all pertinent information related to healthcare interactions, including:

  • When the patient was seen
  • Different appointment typesThe doctors they saw
  • What labs were drawn
  • What tests were performed and their results
  • Any medications prescribed to the patient
  • What the next steps for treatment will be, including follow up appointments or tests

It makes what can be a confusing process for a patient a simple process to follow. It covers everything from intake to discharge, including doctor notes and patient observation from each appointment. It can also be sorted by date.

This takes the guesswork out of appointments, which can often be stressful for a patient, and one part of a very long day for a provider. This documentation aims to bring clarity to health conditions and improve healthcare outcomes. 

Integrating patient data management software in your billing process provides the same level of clarity to the billing side, while improving revenue outcomes. It provides digital access to healthcare bills to determine what services were provided on what date by what doctor, and how much was covered by the patient’s insurance. It clarifies how much is then owed by the patient and how they can settle their bill. It shows a patient how to contact the billing department to answer questions to understand what they owe.

Best Practices for Payer Communication and Billing Process Optimization

The communication between healthcare billing personnel and healthcare payers must be strong. Positive communication to provide clarity and understanding for both sides is important. These important tips can facilitate effective communication with healthcare payers:

Provide Transparency

To ensure prompt payment, it's important to be clear about the patient’s financial obligation before services are rendered. Patients should understand their estimated out-of-pocket responsibility before treatment, and should have questions about their bill answered promptly.

Be Timely

The more a patient’s medical financial obligations increase, the more critical they become of billing departments. For some patients, their impression of a healthcare organization’s billing department can carry a greater weight than the medical professionals who treated them. This makes timely and knowledgeable billing personnel a huge driver in repeat patients. Reducing wait times wherever possible can lead to positive reviews and referrals, and improve quality scores.

Ensure a Customer-Friendly Process

Provide a patient-focused staff member to be available for patients who need clarification. When a patient can reach an administrator familiar with financials, it will reduce the patient’s confusion or frustration. This will lead to faster payment. Empowering a patient with information and making them feel as though there are individuals in the billing department who care about their well-being can reduce collection costs and bolster cash flow.

Be Reasonable

Balances due should be easy to understand for a patient. If the billing structure is out of the organization’s control, they should work with the patient to understand their bill. This can be done by consolidating multiple bills for a single office visit and reducing medical jargon. Jargon makes bills difficult for the average patient to understand.

Streamlining the billing process using technology and automation will make it easier for patients and personnel alike. It streamlines workflows, improves billing and clinical efficiencies, and optimizes productivity.

EDI solutions can help in simplifying payer communication by prioritizing these important aspects of patient care and revenue cycle management.

Future Trends in Healthcare Payer Communication and Billing

The landscape of healthcare payer communication and billing is evolving rapidly due to digitizing the process and incorporating automation. It’s changing so much that healthcare organizations must keep up with new processes, updates, and strategies for staying on top of healthcare billing.

Fortunately, these updates are advanced in that they make the process easier for personnel to manage. Locating records, processing data, and providing information digitally has drastically improved the process timeline from start to finish. 

Future advancements aim to address all the challenges healthcare payer communication is currently facing. This includes ensuring all transactions are properly supported. Some systems can support eligibility checks but not payment. Some payers need both electronic and paper means to complete the transaction. 

Other future coordination involves handling more complex cases, such as:

  • When the patient has multiple insurance policies
  • When a spouse also covers the patient
  • When a vehicle accident involves another driver’s insurance
  • Worker’s comp
  • Supplemental insurance

These complicate the workflows, which need fine-tuning on the automation side to coordinate the benefits of multiple policies.

Electronically-transmitted claims that require editing can also cause issues in the workflow systems. Some payers cannot currently support them. Electronic Payer IDs also create issues when the issuing provider gets acquired by another company. This requires the original ID to be brought under the umbrella of the new entity, which can sometimes be a lengthy process.

Ensuring that billing payment systems are easy to use for both patients and providers means constantly updating the systems to fix bugs, staying updated on legislation involving HIPAA, and maintaining the standards for each healthcare system.

The Office Ally Service Center makes revenue cycle management easy. Its user-friendly process makes it easy to create an account, submit claims and manage your revenue cycle, all in the same day. Similarly, our EHR 24/7 software enables healthcare providers to easily customize workflows, improve productivity, electronically prescribe medications and more. Office Ally takes the guesswork out of managing payer communication and simplifies the billing process with its targeted solutions. Find yours today.