HBMA 2023 wrap-up: top challenges and opportunities for billing companies

A recent poll from MGMA found that more than half (56%) of providers saw increases in A/R days in 2022. Billing companies have an opportunity to stand out by ensuring timely filings, removing barriers to payment, and reducing denials while freeing up providers to focus on their patients.

Based on our conversations with billing industry leaders at HBMA, we saw a few key themes:

• • Challenges around disparate payer clearinghouses
  • Lack of visibility and access to remits
  • Gaps between providers, billing companies, and patients
  • Time-consuming patient statement processes
  • Complicated workflows for handling multiple lines of business and providers

By addressing these potential roadblocks, billing companies can simplify revenue cycle management processes, reduce A/R days, and strengthen revenue for clients.

Challenges around disparate payer clearinghouses

Opportunities for time savings were a common topic of conversation at this year’s conference. We noted that many billing companies use multiple clearinghouses and payer portals, with billers logging in and out of numerous clearinghouse systems to perform day-to-day tasks.

With multiple log-ins for disconnected payer portals and clearinghouses, billing staff are forced to spend precious time doing repetitive and redundant work by hand. With a centralized approach and a single log-in for all government and private payers, billing companies and providers can save time and reduce denials caused by inaccurate patient information.

Lack of visibility and access to remits

Along with the time-consuming nature of disparate clearinghouses, many billing companies are struggling with gaining full visibility into reworked claims and remittances. At the mercy of their clients for this information, delays in claims edits and resubmissions are common. Failure to submit claims in a timely manner often results in increased denials and rejections. The negative impact on providers’ revenue is compounded by diminishing self-pay insurance collections, which have decreased from 76% to 54.8% since 2020.

To strengthen revenue, billing companies must ensure that all billable insurance is identified before attempting to recuperate costs from patients. Instead of playing telephone with payers over reworks and remits, the billing company leaders we spoke with at HBMA were excited to learn about a way to simplify these complex processes while doing more for their provider clients. For billing companies working with disparate practice systems, RCM Intelligence delivers greater visibility by consolidating data for a better view of performance revenue trends. With Inovalon’s integrated RCM solutions, billing companies can gain full access and visibility into active coverage and benefit information, allowing them to reduce denials and achieve fuller reimbursements for their clients.

Gaps between providers, billing companies, and patients

It’s no surprise that billing companies do not have access to their clients’ patients. Incomplete and/or inaccurate patient information leads to denials, but how can billing service companies edit these denied claims to recuperate reimbursements for their clients without access to patient information?

Without the right technology, this can be almost impossible, resulting in delays to timely filing. Instead, billing companies can rely on Inovalon Eligibility Verification and Insurance Discovery to save time, enhance efficiency, and strengthen reimbursements with real-time benefits checks to identify all billable insurance for patients who might otherwise have been categorized as self-pay accounts.

Time-consuming patient statement processes

In a recent survey by U.S. Bank, 44% of healthcare consumers reported that they would pay medical bills faster if billing notifications and statements were sent digitally via email or text. There’s an opportunity here for billing services companies to enhance internal efficiency while providing a service that could significantly improve patient payment collections.

As the healthcare industry continues to face staffing challenges, manual in-house patient statement workflows present a significant obstacle. Billing vendors have an opportunity to save time, streamline patient statement generation, and fight staff burnout. Inovalon Patient Statements offers billing companies a consolidated approach to billing and patient statements with a variety of flexible options for streamlined delivery of paper and/or eStatements, all with a single vendor.

Complicated workflows for handling multiple lines of business and providers

In keeping with the theme of efficiency and time-savings, a lot of the leaders we spoke with raised concerns around how to handle multiple lines of business and types of providers. The legacy solution for this challenge would be to hire more staff, which is not possible for many billing companies in today’s economic climate. Inovalon solutions can accommodate multiple provider rules and easily separate multiple accounts, consolidating and automating this process to free up billers to perform higher-ROI tasks.

Leverage Inovalon technology to reduce denials and achieve more complete reimbursements

At the end of the day, billing companies succeed when they can increase the reimbursement rates for their clients. Inovalon technology helps billing services companies enhance performance with advanced analytics, reduce manual tasks, free up staff time, and reduce denials to help their clients achieve more complete reimbursements.

Schedule a demo today to find out how Inovalon can help you streamline billing processes, identify more billable insurance for your clients’ patients, and send out clear, branded patient statements that help patients pay in a timely manner.

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