The healthcare industry has seen huge technological advancements in many areas, but areas like revenue cycle and billing systems have fallen decades behind.
Brendan English, vice president line of business and content for ASG Software Solutions in Naples, Fla.: Keeping a hospital's revenue cycle process current, accurate and compliant is a difficult task. Oftentimes, bill rejections are caused by charge master errors. What is more, minor errors, discrepancies and "exceptions" are often written-off as losses that are just another cost of doing business. The difficulty is compounded by the fact that most hospitals manage multiple, disparate clinical systems and must synchronize multiple charge masters to ensure accurate accounting for procedures that are performed. Mistakes, such as using obsolete codes from ancillary systems, can cause under-reimbursement for both treatment and materials when claims are generated from the main billing system. Reconciling core and ancillary charge masters stops bill rejection at its source, improves reimbursement rates and helps ensure regulatory compliance.
By implementing automated solutions that can acquire data from any source on any platform, health IT professionals are able to not only create reports and databases that identify discrepancies, but also identify steps that can fix recurring issues. With such solutions, hospitals have both a record of workflow processes for compliance purposes, but also the opportunity to re-direct millions of dollars in "losses" toward research, staffing, patient needs, equipment and more.