Just like any other organization, healthcare organizations face impediments that deter their data collection effectiveness, interpretation, and usage. High level of professional competence is required in the part of healthcare providers to ensure that they deliver exceptional customer service through all departmental levels of their organizations. Professionalism will also ensure that billing and reimbursement guidelines are observed. Outstanding customer service will lead to patient satisfaction which eventually translates to more patient referrals. Research findings have established that patients are more likely to recommend and refer others to a health facility that has experienced and reliable healthcare professional. Referrals increase patient flow which is vital towards influencing the profitability and adding value to a healthcare facility.
Billing
Adopting an efficient billing system will ensure that physicians are in a position to provide reliable and cutting-edge care for their patients and achieve sustained healthcare practice. Better medical billing practices ensure best records for patients are taken and physicians are reimbursed handsomely for the services they offered.
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Billing is done on evaluation and management services offered to patients (E &M). Example of these services includes outpatient consultations and inpatient consultation. E & M services are determined by looking at the history of a patient, type medical examination conducted, and the medical decision arrived by a physician. Medical decisions are made after a physician has performed patient diagnosis and later selecting a management option. Decisions made can either be straightforward, low, moderate or of high complexity depending on the condition of the patient. Physicians should always strive to ensure that they are physically present when a billed service is being rendered. Being physically present and participating when a service is offered will ensure that the correct patient information is documented to shield against overcharging or undercharging services (Lovelock & Patterson, 2015).
Patients’ information should be recorded electronically for easy access and to limit confusion. By using electronic submissions, the percentage of billing insurance claims can increase to about 98 percent as opposed to 70 percent when submitted on paper (Green, 2018 ). Important patient information includes the history of a particular illness, first signs, and symptoms, or medical events in the patient’s family. Evaluating and understanding the needs of each patient is important as it ensures physicians charge a reasonable price for services. Showing concern to patient needs makes them feel that someone cares and wants to resolve their problems. Extending personal care will enable physicians to maximize returns from patients who are insurance carriers.
Adopting better billing administrative procedures will ensure that physicians save more money and outsource expert reimbursement service. National Statistics has shown that poor billing practices cost United States doctors an estimated $125 billion yearly. Common contributing factors to the significant financial loss include simple billing errors and failure to stay up-to-date with medical billing rules and regulations. Billing errors, no matter how small they may look, can cause an insurance company to reject a medical claim. Fixing the errors requires a considerable amount of time on the part of a physician as he/ she has to wait for months before receiving payment for services already rendered.
Physicians can solve medical billing mistakes by either outsourcing medical billing or conducting an in-house medical billing to reduce losses that accrue from ignored claims, denials, and underpayments. Outsourcing billing services involve hiring a third party to take responsibility for billing services. Outsourcing billing services will free doctors a lot of time spent on billing and staffing duties. Doctors and nurses will, therefore, be in a position to improve the quality of care they offer to patients. The contracted medical billing providers charge services provided on a percentage of revenue they bring in the organization. The third-party professional will, therefore, ensure that collection and resubmission of claims occur faster for them to maximize profits. Another advantage of outsourcing is that it saves physicians the cost of frequently training their employees to familiarize with billing software, coding, and procedures. However, not all care providers consider outsourcing billing services as a cost-effective method. Some argue that in-house medical billing is the most cost-effective and ensures physicians have the control of productivity levels in their departments. Any billing problems and questions that might arise are addressed right there, and then by the employed billing staff, this is not the case with outsourcing.
Marketing
There is a need for physicians to adopt an effective marketing approach because the healthcare industry is rapidly growing and evolving. Medical providers should use a marketing approach that prioritizes patient engagement and improved patient outcome. A dramatic shift in the healthcare landscape has made healthcare consumer more involved with their health. It is therefore prudent for providers to adjust to the new market changes by engaging their customers for them to remain relevant and continue generating revenue (Lovelock & Patterson, 2015).
Care providers can ensure customer engagement by adopting necessary technologies that will provide successful healthcare marketing. Such medical technologies include Content Management Systems (CMS), Healthcare Relationship management (HCRM) platform, marketing automation, and engagement center. These marketing technologies personalize marketing campaigns in a way that enrich patient engagements and improve customer service. Personalized service is possible because providers can obtain demographic, social and behavioral information about patients. Providers will, therefore, be in a position to restructure their services according to customer preferences. Personalized services encourage long-term relationships between providers and patients which in turn boosts the revenue flow of medical providers (Lazar, Fleischut, & Regan, 2013) . Adopting better marketing strategies also ensure that care providers grow a steady customer base, decrease their customer acquisition cost, and achieve a reputation as premier service providers.
Reimbursement
Medical providers receive payments for their services using healthcare reimbursement system. The reimbursement system is a complex framework because of the rules governing it changes frequently. Poor claims management causes an adverse impact on reimbursements. It is therefore important for care providers to understand the reimbursement process to take caution against detrimental effects brought by poor claim management. Reimbursement involves a three-step process. The first Step begins with billing and coding of the rendered service by utilizing Current Procedural Terminology (CPT), the second stage is the coding of the diagnosis using ICD-9 (Casto, & Forrestal, 2013) . The last step involves the determination of the appropriate fee based on the resource-based relative value scale.
For healthcare providers to succeed in reimbursements, they should effectively address components of patient-provider interaction like process care, pre-service such as pre-registration, process integrity practices such as chargemaster, billing services, and administrative services like contract management. The above components fit in the revenue cycle and reimbursements will flow predictably when all components are in tune.
Healthcare providers can maintain a successful claim processing operation by having highly skilled personnel who closely monitor the claim process. Keeping track of the claim process will ensure that the reimbursement process is reviewed and is up to date. Ineffective management of the revenue cycle will lead to a rise in billing costs, a drop in collection rates, and an increase in the amount of accounts receivables. Healthcare providers should, therefore, adopt a revenue cycle that ensures effective management reporting of relevant performance metrics, scalable and coordinated and well documented with proper communication policies (Lazar, Fleischut, & Regan, 2013) .
Conclusion
Though physicians are not businessmen, they have to manage their medical practice as a business. Better management of claims, understanding the billing concept and reimbursements, and using the best marketing strategies will ensure that they remain ahead of the competition in the healthcare industry. Operating the medical practice as a business has accrued benefits like increasing revenue flow, expanding customer base, and profit maximization.
References
Green, M. A. (2018). Understanding health insurance: A guide to billing and reimbursement . Cengage Learning.
Casto, A. B., & Forrestal, E. (2013). Principles of healthcare reimbursement . American Health Information Management Association.
Lazar, E. J., Fleischut, P., & Regan, B. K. (2013). Quality measurement in healthcare. Annual review of medicine , 64 , 485-496.
Lovelock, C., & Patterson, P. (2015). Services marketing . Pearson Australia.
