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The Changing Face of Automated Medical Billing Systems

The Changing Face of Automated Medical Billing Systems

While it may not be confined to lodging claims with some of the 90 or so medical aid funds now operating in South Africa, there is no doubt that these interactions tend to form the lion’s share of the medical billing process. Consequently, it is one that, to varying degrees, has been handled by some form of automated system for longer than one might believe.

Utilising technology developed to manage the complex logistics and the huge volumes of related data necessary to conduct the post-war Berlin airlift of 1948, the teletype modems employed at that time were destined to be replaced by the more efficient and more familiar electronic data interchange (EDI) technology that began to gain prominence during the ‘70s. A radical departure from other forms of communication, EDI was not designed to facilitate the transfer of data between individuals but between computers, and without the need for human intervention. Typical examples of data transferred in this fashion are invoices and purchase orders so, not surprisingly, EDI offered great potential as the basis for an automated medical billing system.

This led to the launch of a switch facility that could be used by practitioners to submit claims to any of the medical aid funds within a private network in exchange for a fee ranging from R3 to more than R10 per transaction. It is an option that is still offered today. However, while EDI is secure, quick, and relatively simple, it doesn’t take very long for those transaction fees to mount up. The more widespread use of electronic mail opened another possible means to simplify the claims process. Furthermore, it was an option that would not incur any transaction fees. Though not strictly an automated medical billing system, the use of email to post claims, pioneered primarily by Discovery, meant that healthcare practitioners could simply generate an invoice on a PC using MS Word and email it directly to the appropriate claims-processing department.

While submitting their claims by email still remain the standard procedure for many private practitioners today, it is a time-consuming process that can detract from the core business of patient care unless one is prepared to employ additional staff.  Nevertheless, for a doctor or dentist who is prepared to commit some of their after-hours time to the task, the email route can certainly be a cost-effective alternative to the use of EDI as an automated medical billing system and the specialised software to support it. For the practitioners with the wherewithal, there is now a wide range of dedicated software packages with which to manage the financial aspects of their practice as well as most of its other administrative tasks, if required. Even software intended for the mass market can be costly, so it should come as no surprise that programmes developed for specialised applications such as an automated medical billing system tend to carry prohibitive price tags.

Apart from the cost of purchase, a hardware upgrade may be necessary, as well as someone with IT knowledge to keep the software up to date and working as intended. A more affordable alternative, of course, is to let a third-party service provider bear the cost of the software and the responsibility for maintaining it, and simply outsource the entire task to that provider. Even many of the nation’s medical aids and short-term insurers rely on third parties as a more cost-effective means to process their huge volumes of claims. Clearly, making use of a third party’s automated medical billing system rather than purchasing your own could avoid a substantial capital investment, not to mention freeing the practice from hours of administrative hassles and the consequences of human error.

While having no objection to the pro-rata fee that is generally applied to outsourced services, some practitioners still prefer to retain more control over the affairs of their practice. In such cases, there is another way in which to leverage the rich functionality of a dedicated software program without purchasing it or relinquishing control. Instead, online access to the software can be offered as a service in which practitioners provide the input and can monitor the outcomes, while everything else, including invoicing of patients and collections, is undertaken by the software and staff of the service provider. In South Africa, V Professional Services offers a variety of ways for practitioners to benefit from a comprehensive and efficient automated medical billing system.

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