According to a survey conducted by the Center for Healthcare Leadership and Management, 42% of physician assistants and 20% of nurse practitioners do not know whether claims are billed under their own name. Additionally, the same percentage in both groups of providers are unaware of whether claims are billed under their own national provider identification number (NPI), the physician’s NPI or a combination (1). Culling responses from 3,450 physician assistants and 250 nurse practitioners, the data suggests a communications gap between providers and billing departments that can make it difficult to maximize reimbursement and avoid billing errors (2). There are quite a few ways in which hospitals and health systems can improve communication between providers and billing departments, while also taking steps to reduce waste and increase revenue.
In order to fix the detrimental effects of the communications gap between providers and billing departments, healthcare organizations should turn a critical eye to their supply chain management techniques (3). When it comes to purchasing products and services, providers need to look beyond the basic value analysis approach and focus on hidden costs and areas of financial waste. One of the most common areas of preventable waste is in physician preference items. If healthcare organizations try to meet the particular requests of every provider on the team, they may end up purchasing items that are more expensive than necessary, or bulk supplies that are only used by a few clinicians (3). If these preferences do not actively contribute to patient outcomes or quality care, they may not be in the best interest of the organization as a whole. By consolidating and standardizing the types of items available to providers, organizational leaders may be able to better ensure that the stockrooms are filled with cost-effective supplies that will not go to waste. Better procurement practices, physician and clinician engagement through strong leadership, and communications programs can help hospitals achieve rapid supply cost reductions of 20 percent or more and keep future cost escalations under control (3).
Another way for healthcare organizations to maximize reimbursement and improve communication between providers and billing departments is to implement organizational models that support efficiencies in billing operations and claims management. In a centralized billing model, the majority of billing functions are completed in a central business office (4). The advantages of this model include dedicated expertise, standardized reporting and monitoring, and opportunities for enhanced IT systems (4). Its disadvantages come in the form of increased physician billing and response lag and higher billing costs. In a decentralized billing model, the majority of billing functions are completed/managed at the site of service (i.e., each practice maintains a small business office) (4). On the plus side, it allows organizations to have site-level control, close relationships with patients and physicians and prompt resolution of physician-driven errors. On the negative side, it can lead to disparate standards and processes, as well as staffing inefficiencies (4). The hybrid billing model, a mixture of centralized and decentralized models, can give organizations the best of both worlds. However, this model requires additional training and the implementation of reporting/control tools.
Last but not least, technology may be one of the keys to improving not only internal communications about claims, but the results of the claims themselves. A 2017 analysis by Change Healthcare found that out of roughly $3 trillion in medical claims submitted by U.S. hospitals in the prior year, almost 9 percent of those charges were initially denied (5). Such a high rate of denials creates challenges for maximizing revenue, so it’s important to have the right tools and processes in place. Healthcare organizations should invest in EHR systems and IT services that can perform eligibility-checking. Automated systems that can curb duplicate billing, as well as improper CPT codes, can improve claims management and reimbursements (4). However, while having good tech in place can occasionally help with prior authorization, it’s not solely about the tools. Healthcare organizations need to provide adequate training and education to the people who are processing claims, so that each claim contains the right information before it’s submitted.