Saving lives every day should be a little less complicated, am I right? Yet the healthcare industry is still one of the toughest to be in (hello, 2020 and 2021) and while the life-saving and keeping-our-communities-healthy part is nice, the billing inefficiencies and frustrations are not. Do these challenges sound familiar?
Overseeing a hospital’s finances is stressful – and when you add in missed revenue opportunities to the mix, you might just want to pull your hair out. But here’s the thing: there’s a LOT of revenue of services that your hospital and physicians delivered that you might not be billing for, or billing correctly.
That’s especially the case with infusion billing! In fact, we worked with a major cancer center delivering 130,000 infusions and helped them generate $3.4 million by capturing previously under-reported revenue.
So, you bill for the service, but then it takes 800 years to actually get the cash (at least, it feels that long). When coding is inefficient, it means charges get stuck in a queue and need to be reviewed before you can bill for them, delaying the time it takes to get reimbursed. What if these charges could be scrubbed automatically so they go straight to billing, improving charge lag and cash flow?
Plus, did you know infusion billing is notoriously complex? Add in the fact that many nurses in high-infusion areas such as EDs and cancer centers are the ones who end up billing for those encounters (with little to no training on how to do so). But how do they know what to bill for and what information is critical to making sure you get reimbursed properly? And do it all with a million other things to do, taking time away from patient care? Nurses never signed up to have “billing” added to their job description.
Finally, then add in the fact, that because of this, many hospitals have coders who have to review and fix every single infusion charge before it gets submitted? We’re talking a few coders, eight hours a day, five days a week, and… you do the math. Automating these complex infusion processes means more money, faster. We actually helped a Massachusetts-based hospital automate their infusion billing so that 90% of the charges were able to go straight to billing without any manual intervention.
No one likes a surprise visit from the people in suits who want to audit your financials for fraud. So what puts you at risk? Manual processes, where you’re transcribing notes from a provider’s, ehem, messy handwriting; or your coding team is transcribing straight from the EHR documentation; when you’re missing data and can’t prove a charge; or when coding is so complex that coders manually have to review every charge (#inefficient).
When you consider an area like infusion billing, which is so complex, it’s easy to make a mistake and put you at risk for an audit, or worse. One audit we did looked at 51 infusion encounters and found a 50% error rate when billing. Heads up: If your teams are rounding up or down, that’s a flag for CMS and that puts you at huge risk for audit. I don’t want to toot our own horn but we did help hospitals just like yours get to 100% compliant billing.
I think it’s time to call it like it is: nurses have enough to do without adding billing to their long list of responsibilities, am I right? In this labor shortage, the last thing we need is adding more to a nurse’s plate, especially when it takes away from patient care and they haven’t been trained for it.
In fact, because nurses aren’t trained to bill/code, they may not know the correct information to bill something like infusion procedures correctly. Bottom line: They get overworked and you still miss out on revenue. Time for a change?
Too often, there are charges that you need additional documentation for before you can send for billing. But how do you keep track of what you need? How do you communicate this to providers? For many, it means downloading a spreadsheet of all the charges, and then texting, calling, or emailing providers to find out missing information. Chasing information for days and getting the runaround. One, that puts you at risk for sharing PHI. Two, it’s time-consuming and inefficient. And finally, it means that you never get to learn from the past and improve billing for the future – for example, maybe Dr. Joe Schmo’s charges are always missing diagnosis codes, that could be something flagged for all his charges going forward instead of you manually have to catch it every time.
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