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December 20, 2016
Is It Time to Make Billing a Front-end Task?

Once upon a time, it was possible to consider billing to be a back-end, isolated function performed by staff in the billing office. As more care becomes “managed,” however, the end-to-end process evolved so that billing became an end-to-end process that took place over the course of care: Front-end billing functions are performed at the practice site, where the patient is seen, and back-end tasks are carried out in a central billing office, which may or may not be at the practice site. The interface between both functions — front-end and back-end — needs to be transparent to ensure accountability and to optimize revenue performance.

Billing is now the responsibility of everyone, including physicians; non-physician providers; managers; and front-office, clinical and billing office staff. But what if you could take many of the back-end tasks and move them to the front end, shortening the revenue cycle and improving reimbursements for your providers and facility?

Up-front performance

Currently, charge capture and entry and some coding can be done up front, at the point of care or shortly thereafter. However, with the right approach, traditionally back-end transaction processing — such as billing edits, checking the supporting information for claims, checking coding accuracy, pre-adjudication of claims, statements to patients and claims to payors — can be moved to the front end. This requires a real-time approach that can translate minute-to-minute savings or savings in days to reimbursement that arrives weeks, even months, sooner.

It works like this: The medical scribe documents the patient encounter, to ensure that complete and accurate information is gathered during each visit, minimizing back-end administrative time for the physician. Adding live coding means that the medical scribe not only records the relevant medical information from the patient encounter, but also relays this information directly to billing personnel via live chat, where real-time interaction between the scribe and billing personnel ensures that information that coding done on the spot accurately reflects what is currently happening in the room or at the bedside.

This approach, developed by Queuelogix, lets doctors focus on care without dealing with a backlog of paperwork, allows for more efficient queueing of patient information, prevents errors in documentation, and gets accurately coded claims out the door potentially within hours, instead of days. And every day you get back in A/R, pays off in revenue dividends.

Start the clock ticking

When coding and billing begin at the point of care, the clock starts ticking on the A/R cycle to maximize revenues for services. Keeping this timeline short is critical, because every day that a claim sits in a payor’s system is a day that your practice, physicians or facility doesn’t get paid, costing potentially tens of thousands of dollars a year. Worse, when these claims are inaccurate and rejected, the human resources invested in getting them right the second time around may exceed the revenue generated by reimbursement.

If your coding and billing department is efficient, days in A/R should be fewer than 50 — although 30 to 40 days is preferable. Some experts might say you should aim for under 30 days in A/R, but that may be unrealistic for most care settings, particularly hospitals and emergency departments. In any case, average A/R of 60 days or longer is considered below standard.

Meeting or improving upon these benchmarks is the key to better revenue performance. Real-time coding, performed at the point of service by providers fully trained in and experienced with ICD-10, can help ensure the right level of detail is recorded, to guide your back-office coding and billing staff in creating valid codes and submitting clean claims. Clean claims are the key to more timely payments and keep you from having to engage in the appeals process — which costs you both time and money (not to mention your peace of mind). In addition, point-of-service coding means you can get claims off to payors within hours, rather than days. Timely, clean claims can shave days off A/R, freeing your cash flow to invest in your facility or practice according to your priorities.

Patient-centric benefits

An extra bonus is that patients also benefit from faster coding and billing. In a patient-centric revenue cycle, you should seek to minimize complexity, empower the patient through transparency and information, and generate bills in a timely manner. After all, you can’t expect a patient to worry about speedy payments if you don’t. The real-time interaction, between physician, medical scribe and billing personnel means bills can be sent to patients electronically or by mail within hours, rather than days, helping them pay their share more easily and in a timely fashion.

Care Navigators
As healthcare business models evolve, so should care teams.

Patients who are paired with Care Navigators report feeling less anxiety, and an increased ability to self-manage their conditions between visits. And providers report increased job satisfaction from improved efficiency, and knowing their patients have access to care teams, and strategic support.

Chronic Care Management
With an increased aging population managing two or more chronic illnesses, extending your care teams’ ability to communicate with patients is critical. We take a strategic approach to helping patients chart a path towards their health goals, while self-managing their chronic conditions between clinical visits.

AI Chatbots
We deliver a robust AI Chatbot solution to help manage and sustain effective communication with patients. Care teams implement the conversational text messages and customize patient communication to deliver high quality care.

Nurse Care Team Assistants
Adding a qualified Nurse CTA to the care team increases quality of work-life and reduces stress on nurses. The nursing profession is also experiencing an alarming shortage due to increased clerical burdens and burnout.

Revenue Cycle Management
Transition Revenue Cycle Management into the modern age with a suite of software tools that will transform your billing and coding processes. Transact at lightning speed, with increased transparency and decreased siloes. The QueueLogix software application seamlessly integrates with existing EMRs to ensure the clinical activities and back-office operations are well aligned, monitored and successful.

Referral Management
Referrals scheduled by navigators in the clinical setting builds long term, patient care integrity across the care continuum. With the authority, along with the provider to search for specialists in network, navigators assess their schedules, and ensure appointment compliance.

Scribe Services
There’s a reason why we’re the nation’s most frequently used scribe company: we offer professionally trained medical scribes to meet the specific needs of our clients. We offer a variety of scribe programs, as well as technology and personnel solutions that address revenue cycle management, the transition to value-based care, and more through our HealthChannels family of companies.