Medical billing errors and inadequate claims-denial management have long been culprits in healthcare providers’ revenue losses. But their financial damages have been intensified by the ongoing labor crisis, healthcare regulatory changes and a stubborn pandemic.
Many healthcare systems are turning to extended business office (EBO) solutions to optimize medical billing and claims management and maximize reimbursements. These services pair advanced technology with a skilled support team who understands the nuances of healthcare billing. Working with the right EBO partner can reduce accounts-receivable days, improve overall collections and contribute to a higher net collection rate.
Medical billing and claims management is becoming increasingly complex at a time when providers’ human resources are simultaneously limited and stretched thin.
As healthcare systems cope with staffing shortages, they’re also striving to meet evolving reporting rules, Medicare and Medicaid directives, payer guidelines and interoperability standards. These challenges have upended many providers’ revenue cycles, accelerated the demise of dozens of hospitals and left hundreds more struggling financially.
An extended business office solution bridges existing accounts receivable (AR) and claims-management process gaps and better connects patients, providers and payers. Quality EBO services should be engineered for revenue-cycle efficiency, including improved billing accuracy, reduced claim delays and denials, increased reimbursements and reduced strain on administrative staff.
Though healthcare and insurance EBOs have existed for decades, their benefits have expanded in recent years, thanks in part to technology that offers deep automation capabilities and is designed to meet today’s needs as well as tomorrow’s challenges.
Extended business office services vary by vendor and often focus on accounts receivable-related processes. Still, they can span from patient access through collections if part of a comprehensive revenue cycle management (RCM) platform.
A technology-enabled EBO offers particular benefits in the following key areas:
An EBO should offer easy integration with existing billing software and address end-to-end accounts-receivable needs. An EBO partner should be able to identify workflow inefficiencies and deploy scalable solutions that streamline internal operations, boost claims accuracy, reduce AR days and increase collections.
An EBO that utilizes cutting-edge technology can automate certain AR functions, including collections and follow-ups, generate root cause analysis (RCA) reports, and conduct remittance reviews to recognize and track underpayments. A modern EBO should also supply detailed metrics capable of insights regarding payer tendencies, claim rejection trends and other tools to help financial leaders refine efficiencies, grow revenue and enhance the patient experience.
Though today’s EBOs are technology-fueled, the human element remains vital. A healthcare EBO should focus on healthcare and employ accredited medical coders and other experts who understand the intricacies of healthcare AR and payer variations.
Clean claims are crucial to a healthy revenue cycle. In fact, a recent survey found that a surging number of hospitals are tracking the difference between clean claims and initial claim denials as a leading key performance indicator.
Yet denials continue to rise, and approximately one-third of hospitals experience denial rates of at least 10 percent. An EBO should have a track record of increasing clean claims, billing those claims promptly and reducing initial claim denials.
An EBO’s dashboard and analytics interface should allow claim-status tracking by patient, service provider and payer. It should also monitor for contract-related payer delays and yield actionable data concerning claim-rejection trends.
With the importance of clean claims duly noted, denials occur for several reasons, and some of them aren’t preventable, even with the automation and auditing capabilities of a fully integrated EBO.
Yes, an EBO should improve clean claims and mitigate denials. But an EBO partner must also be capable of efficiently managing technical and professional fee denials when they occur.
A healthcare EBO that employs certified medical coders can reduce the coding errors contributing to a significant portion of denials and quickly address any coding-related inconsistencies or denials. An EBO should also provide detailed denial and collections reporting so financial leaders can track resolutions and claim-adjustment reason codes (CARCs) and remittance-advice remark codes (RARCs) for insights about denial trends.
One of the most significant risks to the healthcare revenue cycle — and access to federal healthcare programs — is the dreaded credit balance. An effective EBO can quickly prioritize and process credit-balance backlogs, identify and fix erroneous adjustments or credits, and discern improper debit codes.
With healthcare data breaches on the rise, security is an across-the-board priority for healthcare providers and their partners. Security is paramount to credit balance resolution, and an EBO’s security protocols should include alignment with SSAE 16 auditing standards and compliance with HIPAA regulations.
The EBO platform should also offer credit-balance tools that can identify and monitor refunds and incorrect postings. This technology should be supplemented by a team of analysts accredited as certified patient account technicians (CPAT) by the American Association of Healthcare Administrative Management (AAHAM) and understand the gravity and complexity of credit balance resolution.
As patients take on a greater financial burden for their healthcare services, the ability to determine a patient’s responsibility and offer multiple payment-capture options are integral to the revenue cycle.
An EBO should maintain expertise across all payer fronts, including private insurance, managed-care plans, Medicare, Medicaid and Medicaid state plans, and other programs. An EBO platform should be able to verify patient benefits and calculate patient financial responsibility up front.
As patient demand for online and remote health services broadens, effective EBOs must also support multiple payment methods for greater collection potential and implement technology that augments patient contact until reimbursement. An EBO that employs artificial intelligence and machine learning can parse patient data and generate so-called “propensity-to-pay” scores to create friendly, patient-focused contact campaigns that improve connection ratios and payments.
GeBBS Healthcare Solutions is an innovative leader in EBO and RCM services. We’re dedicated to helping our partners amplify their revenue cycles through comprehensive platforms that achieve measurable results.
GeBBS’ extended business office and revenue cycle management solutions have earned acclaim for their AI-driven automation capabilities and real-time analytics. GeBBS is proud to be recognized as one of Modern Healthcare’s Top 10 Largest RCM Firms, Black Book Market Research’s Top 20 RCM Outsourcing Services and Inc. 5000’s Fastest-Growing Private Companies in the United States.
If you’re ready to explore how an extended business office can help your organization improve workflow efficiency, reduce costs and rev up revenue, connect with GeBBS today at gebbs.com.