Balancing Patient Care and Healthcare Claims and Billing

When we ask dental and healthcare providers about the hardest part of running a practice, many tell us it’s what happens outside the exam room–managing the business side of the practice. The fact is  most HCPs didn’t go to business school, and what many of them find most challenging is balancing patient care with caring for the revenue and growth of their practice.

Most doctors and dentists go to medical school on a mission to help patients meet their health goals. What they don’t go to school excited about is helping administrative teams navigate insurance or manage revenue cycles. Yet it’s critical to master both skill sets, and balancing patient care against business demands can be stressful. Fortunately, there is a way to put patients first while managing healthcare claims and billing.

Quick Links

• The Dual Role of HCPs: Healthcare Billing and Patient Care
• The Impact of Healthcare Claims and Billing On Healthcare Staff
• What is a Patient-Centric Approach to Healthcare Billing?
• Applying a Patient-centric Approach to Healthcare Claims
• Strategies to Improve Healthcare Billing and Claims for Your Staff and Patients

The Dual Role of HCPs: Healthcare Billing and Patient Care

One of the biggest challenges facing HCPs is the dual role they must play as both care providers and business owners. As care providers, the top priority is ensuring patients receive the care they need from their medical or dental practice.

When it comes to patient care, HCPs must diagnose illnesses, prescribe treatments, perform procedures, offer counseling, and ensure the well-being of patients. Patient care involves direct interaction with patients, their families, and other healthcare team members to address medical needs, alleviate symptoms, and promote health or healing. From qualified staff who can tend to patient needs to ample time to provide quality of care, for many HCPs, human resources are a challenge, especially with staffing shortages. 

As a business owner, HCPs must ensure their bills are paid and this means monitoring accounts receivable. Of course, this includes both insurance payments and patient copays or out-of-pocket expenses. But, it’s really more than that.

Healthcare billing and claims requires recording patient information, documenting medical procedures and services provided, assigning appropriate billing codes, and submitting claims to insurance companies or government payers for reimbursement. Healthcare professionals also play a role in addressing billing inquiries, resolving billing discrepancies, and ensuring compliance with regulatory requirements related to billing and dental or medical coding.

While patient care remains the primary focus, efficient healthcare billing is essential for revenue cycle management and a healthy practice. Striking a balance between these two roles is, therefore, crucial. However, many HCPs find these sometimes conflicting roles can be complicated. 

The Impact of Healthcare Claims and Billing On Healthcare Staff

With the laundry list of tasks for each of these roles, it’s easy to see why one of the primary challenges HCPs face in managing both patient care and healthcare billing is time and resource constraints.

Because patient care is often a top priority, it can leave limited time for administrative tasks such as billing and coding. Further, with the ever-changing regulations and requirements for  healthcare billing, HCPs and administrative staff may struggle to keep up. As a result, insurance claims may include errors resulting in claim denials which, ultimately, lead to delays, more staff time and potential revenue loss.

Ultimately, it can impact not only the financial health of a medical or dental practice but also pose a risk to patient care and satisfaction. Patient satisfaction is often a key indicator of practice health, but what happens when administrative staff must also manage A/R and collections? If a practice’s financial health hinges upon uncollected or unrealized revenue, then eventually this business role must take precedence.

For some, there is an inherent conflict when healthcare staff needs to prioritize the financial interests of your practice over patient care activities or tasks. Similarly, no one wants to make collection calls, especially if patients with whom you have a solid and long-lasting relationship are struggling to pay healthcare costs. Plain and simple: this leads to friction which can be stressful for patients and staff alike.

However, employing a patient-centric approach to your medical or dental practice can and should extend to your billing practices. 

What is a Patient-Centric Approach to Healthcare Billing?

Simply put, this approach puts the patient at the center. That means prioritizing the needs, preferences, and experiences of patients throughout the healthcare billing process.

Key elements of a patient-centric approach include:

1. Transparency - Provide clear, understandable information about the costs associated with healthcare services, including treatment options, insurance coverage, and out-of-pocket expenses.

2. Communication - Engage in open and proactive communication with patients regarding billing processes, potential financial obligations, and available support resources. This may include reminders and going over financial obligations multiple times.

3. Empowerment - Equip patients with the knowledge, tools, and support they need to navigate the billing process. Sometimes patients are unsure about what their insurance covers vs what they’ll owe out-of-pocket, so they might even choose not to move forward with treatment. A patient can make their best healthcare decision when they have the clear information they need.

4. Accessibility - Make billing information, payments, and assistance readily accessible to patients through multiple channels, such as online portals, mobile apps, phone support, and in-person assistance.

5. Flexibility - Consider offering flexible payment options, financial assistance programs, and personalized solutions to accommodate patients' financial challenges. When it comes to healthcare billing and tough situations, finding ways to build and maintain relationships is key.

6. Accountability -Take responsibility for addressing and resolving billing-related issues promptly and effectively, including errors, discrepancies, and concerns raised by patients. Delays create confusion and unnecessary tension.

7. Continuity of Care - Integrate billing processes into the patient care experience by using familiar tools. Provide the same level of communication, support, and assistance across all aspects of your services.

Overall, a patient-centric approach to healthcare billing can help enhance patient satisfaction, trust, and loyalty. Establishing patient-centric practices and protocols can contribute to improved patient outcomes and overall practice health, not to mention a far easier process for an already overburdened administrative team.

Applying a Patient-Centric Approach to Healthcare Claims

Those same practices and policies for patient-centric billing also apply to healthcare claims. As noted, with new jobs, evolving or changing healthcare plans, and an increasing shift to high-deductible insurance, many patients are already frustrated by healthcare insurance.

A patient-centric approach to healthcare claims and insurance also puts patients and their understanding at the forefront. Practice tools, like automated insurance verification, can help prepare your administrative staff to tackle these practices. With all the coverage information your team needs, in advance of an appointment, they’re best prepared to engage in the open communication and transparency that is the foundation of patient-centered care.

Because one key aspect of patient-centric healthcare claims is empowering patients with information and resources, your team must first have access to that information, and in a timely way, prior to appointments and procedures. Providing accessible explanations of benefits, offering guidance on insurance coverage and deductibles, and facilitating discussions about treatment costs upfront helps patients understand their financial responsibilities and options.

Moreover, embracing technology and innovation can play a pivotal role in enhancing the patient-centricity of healthcare claims processes. From user-friendly online portals for bill payment and claims tracking to leveraging artificial intelligence for faster claims processing and resolution, technology can streamline administrative tasks and improve overall efficiency while keeping the patient experience at the forefront.

Ultimately, adopting a patient-centric approach to healthcare claims isn't just about fulfilling administrative requirements; it's about recognizing the human element in every transaction and interaction. Prioritizing empathy, communication, and patient empowerment, can help nurture stronger, more meaningful relationships with patients, rather than creating tension or unnecessary stress, for anyone.

Strategies to Improve Healthcare Billing and Claims for Your Staff and Patients

So what strategies can you employ to ensure patient-centric healthcare billing and claims? And, how can those same tools help your staff?

Improving healthcare billing and claims processes with a focus on patient-centric care involves prioritizing transparency, accessibility, and communication. Thankfully, many of these same strategies equip your team to handle the same administrative tasks and to do so efficiently and effectively, freeing them up for patient care and practice critical tasks.

1. Transparent Billing and Communication. Prior to treatment, discuss costs clearly and plainly with patients so they understand the procedure, its necessity, insurance coverage, and any out-of-pocket expenses. Provide patients with clear, easy-to-understand explanations of their bills, including itemized charges and any adjustments made by insurance.

2. Patient-Friendly Statements. Design consistent billing statements with the patient in mind, using plain language and visual aids to enhance comprehension. Highlight important information such as payment due dates, outstanding balances, and available payment options.

3. Accessible Billing Resources. Make billing resources and payment portals easily available to patients and employ multiple channels. From printed bills and online portals to mobile payments using digital wallets they already know, you can simplify and streamline the entire billing and payment process. Finally, make sure patients know where to go for help should they have billing questions or concerns.

4. Empowerment Patients with Education. Patient education goes beyond helping them understand treatments and procedures. To truly take control of their healthcare finances patients need to be educated about everything from healthcare billing terminology and insurance basics, to their rights as healthcare consumers. Provide educational materials and resources in multiple formats to accommodate different learning preferences.

5. Provide Responsive Customer Support. Heading off problems at the pass (and extended revenue cycles or delayed payments) is often as simple as being responsive to patient requests. Ensure patients can easily reach a knowledgeable representative who can assist them with billing-related issues.

6. Solicit Patient Feedback. Patient feedback, specifically about their billing experiences, can help you refine your policies and practices. You’ll be able to identify both areas of friction and frustration.

7. Leverage Partners, Technology, and Automation. Patients take time and patient-centric approaches require a human touch. That means you need to optimize your operations to allow your staff to step in when and where human interactions are required. To do that, you need to leverage both partners and technology which can help you with everything from insurance verifications to healthcare billing, claims, and payments. 

By implementing these patient-centric strategies, you can improve the billing and claims experience for patients, leading to increased satisfaction, better financial outcomes, and stronger patient-provider relationships.

If you’re looking for the resources and technology tools that can optimize patient care and maximize the efficiency and profitability of your business, then look no further. iCoreConnect is designed to be customer-centric, focused on you and the needs of your practice so you can be patient-centric.

Reach out to our team today, book a demo, and we can discuss our suite of products designed to impact and improve every aspect of your healthcare practice.