A Payer’s Role in Streamlining the Medical Billing Process

The medical billing process is complex and tedious for all involved. Both patients and providers benefit when the medical billing process can be streamlined in some fashion.

Most individuals agree that the medical billing process is not straightforward. Patients, in particular, want to understand how much they will pay for their medical care, especially when the possibility of obtaining medical debt is on the horizon. Professionals working within the healthcare industry cannot settle for medical debt relief or medical debt forgiveness programs alone. Patients need to be able to make informed decisions regarding the healthcare they receive and to do this. The medical billing process needs to be simplified so that it is understandable.

Effective Ways for Payers to Simplify the Medical Billing Process 

The term “payers” most often refers to a patient’s insurance company. A patient’s insurance company works to process a claim after medical care has been received.

Payers have a significant role in the medical billing process. Most notably, payers are responsible for ensuring that patients understand what is covered under their medical bills. The medical billing process, as a whole, would benefit significantly if payers could effectively simplify their role within medical billing.

There are multiple ways to streamline payer medical billing processes. The most effective tactic for payers to simply the medical billing process is through embracing technology and automation. Most modern industries use technology and automation to streamline their workflows, and healthcare should be no exception.

Blue Shield of California: An Example of Streamlined Medical Billing

In California, Blue Shield, a major health insurance company, leads the way, creating innovative methods for streamlining the medical billing process. The program has been wildly successful. According to one report, 92% of Blue Shield members utilizing the program are satisfied.

The program, coined, Member Payment Pilot program, streamlined payer medical billing processes by embracing technological software. Collectively, the program simplifies both billing and payment processes for patients. The technology prides itself on being user-friendly. It sends text message updates to patients and allows patients to log in and pay their bills using various options.

The Member Payment Pilot Program in California also tries to simplify the billing process for physicians. In this program, the health insurance company elects to pay the patient’s balance, and in turn, coordinates payment with the patient independently to get those funds back. The program reports that providers are pleased with this initiative because it allows their office to focus on client care rather than the account balance. It also reduces the overall general cost for the provider.

The insurance provider is also considering robotic automation further to simplify administrative processes within the medical billing process.

Finally, Blue Shield is working to decrease the turnover time for claim settlements. The agency has achieved a turnover time of about 6 days, down from 30 days. The company claims that they hope to reach a turnover time of under 10 seconds eventually.

The Takeaway for Other Payers in the Healthcare Industry

Blue Shield of California has set the bar high for streamlining the medical billing process. Other payers in the nation can gleam from the successes of Blue Shield’s program. Without a doubt, other health insurance companies could streamline the medical billing process using technological software similar to that of Blue Shield. Likewise, payers could also consider utilizing robotic automation to reduce the administrative burden.

Most importantly, payers need to simplify the billing structure and provide patients with easy-to-access and easy-to-use payment options. Payers can further streamline the medical billing process, like Blue Shield has, by funding a patient’s health costs upfront. Lastly, payers can streamline medical billing processes by reducing the amount of time it takes to process a claim.

Other Recommendations for improving upon the medical Billing Process

The Department of Health and Human Services recognizes the short-term medical billing in our nation’s healthcare system. They have recently proposed enacting a standardized claim form for all payers and health insurance agencies to address this. 

There has been positive feedback about these sentiments from providers at institutions like Massachusetts Regional Hospital. Reportedly, these providers also believe that a required s standardized claim form would streamline the medical billing process. These individuals believe that standardized rules for payer claim submission should also follow.

Final Thoughts

It is imperative that medical billing solutions are found and that medical billing processes are streamlined. Patients deserve to understand their medical costs. Patients also deserve to have easy access to view and pay their medical bills. 

Payers, in particular, play a significant role in the medical billing process. Consequently, payers, such as Blue Shield of California, have a substantial responsibility to help patients better understand their medical bills and make the process as easy as possible.

Payers can simplify the process of medical billing with the help of technology and automation. Additional options for improving upon the medical billing process could include implementing standardized rules and forms for insurance agencies. 

The process of streamlining medical billing is not immediate. Improvements will take time,  but as other payers have already demonstrated, it is possible.