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Pitfalls of Medical Billing

How Smart Software Can Bypass the Pitfalls of Medical Billing

To the layman, it might appear that the process by which a private practitioner obtains their income is unlikely to differ greatly from that which is applicable to other professionals. In reality, however, it involves a combination of two processes. The more straightforward of the two relates to the invoicing of patients from whom they must often also collect upfront payments. Like the clients of attorneys, finance companies, and tradesman, doctor’s and dentist’s patients often pay late or default, prompting the need for legal proceedings. However, the second component of the medical billing task; that which involves submitting claims to medical aid funds, is a path littered with pitfalls, and one that regularly leads to millions of lost revenue for South Africa’s healthcare professionals every year.

While legislation leading to the formation of the Council for Medical Schemes (CMS) to regulate the activities of the nation’s medical aid funds have done much to protect their members, control their premiums, and expedite their claims, there has been little attempt to simplify or standardise the processes by which doctors are required to present their claims. Consequently, current governance relating to medical coding and billing is lacking in clarity and can leave practitioners uncertain, confused, or bewildered.

With no better option to call upon, private practitioners have, for years, found it necessary either to incur the added cost of hiring suitably competent staff to attend to the finances and other essential administrative tasks, or to undertake these tasks in person. The latter choice meant either working after consulting hours or spending less time attending to the needs of their patients – neither of which is a good option. It is therefore good news that there is now a far more efficient and cost-effective alternative approach that relies upon specialised software to speed up and to simplify the medical billing procedure.

The potential time saving offered by a computerised solution can be a huge benefit and could mean less of the practice’s income spent on staff or overtime hours, as well as increasing the time available to accommodate more patients and, as a result, providing a means to generate some welcome extra revenue. While many doctors have already accepted the need for computers as a convenient means to store and access their patients’ records or to host the appointment diary, they remain committed to manually dealing with the vagaries of medical billing without the support of a suitable software solution.

When faced with making the transition to a more comprehensive automated system, many doctors are a little reticent. This is understandable, given that experience has probably taught them that the cost of acquiring bespoke software and the possible need for hardware updates could require a substantial cash outlay. In addition, they may harbour concerns that their lack of IT skills might make it necessary to hire a computer specialist as well as being faced with the cost of paying for any prospective end users to undergo training in the use of the new medical billing application.

While, in fact, their fears regarding the associated cost of purchasing such a system could well be justified in the case of certain products, this is not the only option. There is now a perfectly sound option that enables a healthcare professional to enjoy all of the benefits offered by a state-of-the-art software solution while incurring none of the off-putting expenses referred to above. Known as “software as a service” or SaaS, it is a concept first introduced during the ‘60s when the owners of IBM mainframes began to provide remote bureau services such as storage, processing, and access of data for insurance companies. The application of SaaS in medical billing, however, only became feasible with the birth and subsequent meteoric growth of the Internet and the expanded availability of connectivity.

An affordable SaaS solution not only means doctors avoid the considerable upfront cost of a purchase but, as the software is hosted remotely, the service provider is solely responsible for all maintenance, updates, and data security. For an affordable monthly fee, practitioners need only a browser and broadband to access the full functionality of a system primed with all the correct codes to ensure that the medical billing process is always fast and error-free. If you want a more efficient and more profitable practice, give V Professional Services a call.

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