Addressing Inefficiencies in Patient Billing and Claims Reimbursement

As we’ve talked about in a previous post, an unintended consequence of increased patient responsibility has been rising expectations around the patient experience itself. It can be argued that no part of the experience is more broken than billing, and, when applicable, patient-side reimbursement. Seemingly everyone has a horror story of a billing or claims issue that wound up consuming hours of time and left them feeling like the system is irrevocably broken. With that as the backdrop, both healthcare providers and a few startups are leveraging technology in an attempt to alleviate the problems.

In a survey conducted by Waystar and HIMSS, nearly all health organizations said they billed using paper-based systems, despite more than half of patients preferring to be billed electronically. The reasons for this preference should not be a shock to anyone – why would consumers who pay for nearly all other goods electronically want healthcare to be any different? In an environment where one can place grocery order online to be delivered that same day, the concept of paying a medical bill in the same fashion as decades ago seems even more jarring. Another sign of a significant issue is a disconnect over when and if patients are even currently paying on time. In the above-mentioned HIMSS survey, 48% of healthcare executives reported that patients take more than three months to fully pay their financial responsibility, while only 24% of patients said it takes them that long to pay. Regardless of who is actually correct, confusion over dates and when patient responsibility after services are rendered is determined is clear.

So what is the technology world doing to address this? For those providers who would rather not do it themselves, startups are stepping in to try and fill the need. The early results are telling for the broader opportunity – one startup noted a 60% increase in self-serve payments, a 50% reduction in time to collect receivables, and an overall 35% increase in total collections. With the healthcare market poised to grow from $50B to $90B over the next five years, even small improvements in metrics can have a major impact.

Patient-side reimbursement can be even more frustrating for patients trying to get reimbursed for qualified out-of-network claims. This seeming niche billing segment is enough of an issue that it has attracted startup activity as well, where several offer the opportunity for patients to submit out-of-network claims in seconds. Behavioral health providers like those in mental health services are still 40% out-of-network for most patients, yet represent 10-15% of the outpatient market overall, with growth expected to continue. Something needs to change.

Whether through startups or in-house, streamlining the billing process through technology will be critical in a future that will only see significant increases in activity and claims. Are you ready for the future? At Aquina Health, we certainly are. Offering working capital for healthcare providers through Praxis, instant claims payments through Via, and patient funding through Curae, we’re doing our part to fill the gaps in healthcare that exist today.