In the clinical environment, the mantra is clear: we have to put patients at the center of care.
But when it comes to billing and reimbursements, the reality is, the patient has always come last.
Anyone who’s been a patient recently knows this all too well. You receive the bill and have no idea what the codes mean or why you owe what you owe, or why a procedure is covered at a certain amount in one case, but in another, it’s not covered at all. You might even get the bill before the insurance has been applied, so it’s not necessarily what you actually owe. And if the billing office miscodes or makes a mistake in how the claim is filed on your behalf, you’ve got a whole other battle to deal with.
At best, the process of payment billing is confusing. At worst, it can be overwhelming and stressful, all at a time when you’re at your most vulnerable. The bottom line, says PatientFocus CEO and Founder David Frederiksen, is that the bills patients receive simply aren’t clear, consistent or convenient.
With the economics of healthcare changing, patients are going to be spending more and more out of pocket for their healthcare—and they’re going to start voting with their feet. If they’re unhappy with the way a hospital or doctor’s office handles the billing process, they’re not going to go back. And that means providers are going to have to do a better job of explaining why the patient owes what they owe and how they can pay it over time.
But that magnifies a problem: patient billing isn’t an easy task.
The Complexities of Patient Billing
While most billing offices have gotten relatively good at billing insurance, Frederiksen notes that the process itself is very technical and tedious. Not only that, he says, “the processes, systems and workflows necessary to bill insurance have absolutely nothing to do with helping patients understand and pay their bills. Nothing.”
From the provider’s perspective, there’s a much larger group of payers to deal with now that patients are increasingly paying more out of pocket. Instead of five insurance companies, they might have 50,000 patients to bill. Beyond just the sheer numbers, collecting from a patient is also an entirely different process than collecting from an insurance company.
Adding to the challenge is healthcare’s lengthy revenue cycle. As a patient and claim move through the cycle, hundreds if not thousands of companies could play a small role in that process. The complexity involved with all of this can create collections and cash-flow issues for the provider, while the negative patient experience can ultimately have a lasting effect on the practice’s business.
The keys to patient billing may be simple, but the execution isn’t. In fact, patient billing requires a whole different set of systems, skillsets and workflows to do it right.
The Role of Flexible, Scalable Healthcare Technology
A provider could try to manage this new world of patient billing with Excel spreadsheets and a variety of assorted systems and programs, or they might decide to build their own custom solution. But in many cases, they end up trading one problem for another.
Frederiksen knows firsthand. When he founded PatientFocus, a technology-enabled service that handles patient billing for providers, he initially hired a team of developers to create a custom-built solution to accommodate the unique workflows of patient billing. But he quickly learned that a custom solution was tough to manage over time. It wasn’t sustainable for growth. It couldn’t scale. And it couldn’t easily change with their clients’ changing needs. In a healthcare environment where change is constant, that’s a huge problem.
So they turned to Salesforce.
“Configurable software like Salesforce is like building something out of Legos,” he says. “It comes apart, you can put it back together, you can build whatever you want. It’s designed to do that.”
In addition to incorporating their own workflows and best practices, PatientFocus is able to partner with a variety of small niche platforms that play a role in the patient claims process because Salesforce integrates so seamlessly with other systems. Ultimately, Fredriksen says, running patient billing on Salesforce is not only faster and cheaper, it delivers better reporting, better insights and more value than anything they could have built themselves. And most important, it put the patient at the center of the billing process and works around their needs.
As the economics of healthcare continue to evolve, patients are going to have to pay more. And because they’re going to be paying more, they’re going to be demanding more. The healthcare providers that partner with technology providers who can help them keep the patient at the center are the ones that are going to be successful.
David Frederiksen joined Virsys12 CEO Tammy Hawes on Episode 2 of our podcast, “How I Transformed This.” Click here to listen to their discussion on patient billing, which inspired this blog post.