The hospital billing expert performs activities to control and analyze the flow of the organizer’s expense cycle . Among their activities are:
- Organize, check and preserve medical records
- Control and organize signatures and stamps of the medical staff
- Track rules based on standard forms and indicators
- Check the justification and prescription of services
- Avoid, identify and analyze glosses and their causes
- Analyze financial gains (from health plans and patient rights payments)
- Intermediate the acquisition of government exemptions and resources
- Act on the hospital’s operational strategy
- Record data related to Industry standard
Therefore, the medical billing service expert is involved in practically every sector of the organizer.
The team must be aware of the expenses generated by the medical team. Commercial, administrative, tax and financial costs as well.
Based on this, the team cross-references this amount with net revenue and, from there, identifies bottlenecks and opportunities.
When it comes to the patient’s journey, the billing expert works through their medical records, which record everything from the patient’s admission, the period of hospitalization, exams and medications used, in addition to the costs generated for the surgical center, until their discharge.
Controlling this process is essential to ensure that no item is glossed , that is, not charged.
Unfortunately, the sector still lacks efficiency to a large extent due to the maintenance of obsolete processes, such as manual management.
However, thanks to technology, the emergence of electronic medical records and other automation solutions have increasingly gained space in the routine of hospital management.
In fact, the adoption of some type of Artificial Intelligence is already a reality in the vast majority of private hospitals in the USA.
In larger hospitals, it is also necessary to implement Sector Interfaces with the aim of unifying and fragmenting indicators for each sector of the hospital.
Tools that can help with hospital billing
Among the activities of the hospital billing expert are tools and standards that are specific to the healthcare sector. For example, if you have a radiology billing services expert you will go for him rather than others.
Basically, the data generated in hospital processes are recorded in Industry, a supplementary health information exchange standard.
Much of the team’s work involves reference tables (AMB, CBHPM, TUSS) which are standards for regulating the health sector.
You can get an idea of this from the “Unimed Insurance Reference Table of Exams, Procedures and Therapies. In it, you can understand how the operator guides the application of co-participations related to exams, consultations, therapies and other procedures.
The data is based on the TUSS table from the Healthcare department . This table is constantly updated, forcing changes to the operators’ reference tables. Therefore, it is important to keep an eye on it.
Negotiations involving package models and contracts with operators and suppliers, for example, are also part of the hospital billing expert’s routine. This service is extremely important, as the packages between hospitals and operators will define in detail what the agreement will cover, item by item. If this is not followed to the letter, there will be a gloss.
And for this, there are package models. Taking as an example the adoption of Orthoses, Prostheses and Special Materials , generally associated with high costs, invoicers can act in two models:
When there is no package:
After a technical analysis and subsequent authorization of the agreement, the hospital acquires the special material providers from suppliers and passes on the commercial costs to the agreement, in addition to the invoice itself.
When there is a package:
In this case, the management of the special material industry is done directly by the hospital, without depending on the approval of the operators. In other words, no commercial fees are passed on to the operators.
But there is also a direct billing option, in which the supplier negotiates commercial rates directly with the operators, without going through the hospital.
Additionally, operators can also outsource this negotiation.
To maintain control over these processes, the use of protocols is essential. These protocols contain all the guidelines agreed upon with the health insurance organizer. This helps the technical team to apply materials necessary for a patient’s procedure, dispensing with those that are not or are not covered by the contract. In the latter case, the hospital requests a technical analysis from the health insurance organizer to authorize the procedure.
Indicators are necessary! Find out why:
How can I monitor my management and know which direction I am heading? With the right indicators, you can measure key points of your hospital revenue and make decisions.
Check out the main indicators below:
Invoicing
This is basic and its function is to calculate the hospital’s total revenue. From this, it is possible to see whether costs are higher or lower than the revenue achieved.
Therefore, it is important to centralize data so that indicators are constantly evaluated.
Furthermore, patient records must be filled out correctly so that an effective analysis of the organizer’s financial situation can be carried out.
Any gap in information or incorrect filling can result in the dreaded glosses. And we don’t want that, do we?
Profitability (ROI)
It is used to calculate the return on investment (ROI). This way, you can measure the efficiency of the costs generated. You can calculate the overall ROI of the hospital, or from segments of your interest, such as profitability by health plan, doctor or hospital sector.
Return on Equity
Return on equity is useful for measuring the profitability of your healthcare business. It is calculated using investors’ resources and the hospital’s own resources. Below is the calculation formula:
ROE = Net Income ÷ Equity
EBITDA
This is an indicator that measures how much your hospital generates resources from its operational activities. Taxes and other external effects are discounted.
The idea is to measure how much the organizer is able to generate cash within a historical period and compare it with other competitors to measure its competitiveness.
Smart Method
Very useful for managing processes and people in monitoring their goals, the method is based on:
- Specific: your goal must be specific. No beating around the bush or delays. Ex: reduce monthly glosses by 5%.
- Measurable: for each goal, establish an indicator that will guide its achievement.
- Attainable: create ambitious goals, but within what your hospital is capable of achieving.
- Relevant: Are the goals relevant to achieving your strategic planning? It is important that there is this alignment.
- Time bound: has to do with defining deadlines.
CONCLUSION
Well, if you’ve read this far, I hope you enjoyed the content about the hospital billing sector.
In this article you were able to understand that:
- Hospital management faces global challenges.
- Waste of resources is one of the biggest challenges to be overcome.
- Hospitals that anticipate new technologies should come out ahead.
- Hospital billing affects every aspect of your hospital and can be considered as a sector and as a process.
- There are typical indicators and tools for hospital billing experts that need periodic updates.
- Strategic methods are essential to achieving your goals.
- Automating some processes is the ideal solution to save millions.
