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Efficient Medical Billing Solutions

Efficient Medical Billing Solutions are the Key to Practice Success

Even though the primary aim of any healthcare professional is to provide his or her patients with the care required to ensure their good health, in order to do so, it is essential to focus also on the welfare of the practice and of those it employs. Like a retail outlet or a plumbing service, private medicine is a business that requires an adequate and regular income to sustain it. Unlike payment procedures in most other businesses, however, medical billing presents some complex aspects that require unique solutions. While the retailer and the plumber require no more than a smart cash register and an invoice book respectively, the bulk of a doctor’s, a dentist’s, or any independent healthcare provider’s income must be claimed from one of South Africa’s 90 or so medical aid funds.

While some service providers adopt the approach of requesting payment from the patient up-front and leaving it to him or her to claim any reimbursement due from the appropriate fund, this is often impractical where the cost is substantial. Insistence on this practice can also force patients to seek the services of another provider. If the responsibility for claims is to be retained in-house, however, one of the available medical billing solutions is likely to prove necessary.

Perhaps the simplest approach might be to appoint someone to handle the accounts for the practice. Maintaining a balance sheet and keeping an eye on debtors and payments due should present no problem for an experienced bookkeeper. However, the completion and submission of medical aid claims will generally not fall within the experience of the average incumbent, and thus, some instruction and supervision are almost certain to be required.

The strict insistence by the claims processors on details, such as the use of practice and treatment codes can be confusing, and unless used correctly, could result in non-payment. While greater care with medical billing solutions can help to minimise the occurrence of such problems, human error can never be totally eliminated. As a result, the most effective options rely on the power of specialised software to automate the financial tasks of a private healthcare practice.

For those who may be familiar with a particular spreadsheet programme, it should be a relatively simple matter to write a few macros to simplify the general accounting requirements and print invoices, However, to generate essential reports, such as that required by SARS, and to complete claims submissions requires rather more sophisticated medical billing solutions, and in practice, some are sufficiently sophisticated to manage all of the other financial tasks of the practice as well. These might include managing the staff payroll function, including calculating deductions, generating payslips, and submitting details to the receiver of revenue.

Not only should a well-designed software package be able to prepare all of a practice’s medical aid claims quickly and flawlessly, but it should also be able to invoice co-payments due from patients that can arise when the amount paid by their medical aid funds may fall short of covering the full cost of their treatment. In such cases, a sufficiently comprehensive medical billing solution will be able to check if the required co-payments have been received, generate reminders to those whose payments are overdue, and proceed to initiate recovery measures should prolonged failure to pay make this necessary.

Saving time that is better spent on the core responsibility of patient care offers more opportunity to take on additional patients while ensuring that all payments due are received in full and on time, provides the vital cash flow needed to keep the practice operating at peak efficiency. It is therefore surprising that many private healthcare practitioners in South Africa still continue to avoid the use of automated medical billing solutions.

Generally, their reticence derives from two main concerns. The first of these is the cost, and given the high price of specialised software produced for limited markets, their concern is understandable. The other concern is that the management of such systems requires a level of IT expertise beyond that of the average practice.

In fact, both of these concerns are largely unfounded. Firstly, all upfront investment can be avoided. V Professional Services offers access to its comprehensive software as a service to provide a medical billing solution that is affordable to all. In addition, the client/server arrangement provides round-the-clock access from anywhere, via a web browser, while all technical responsibilities are handled server-side, by the service provider.

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