Medical billing software: the future of RCM

Published: May 7, 2024 by Experian Health


Medical billing is the first line of defense against claims denials. However, medical billing errors cost U.S. healthcare systems approximately $935 million weekly. Not only do preventable errors wreak havoc on providers’ revenue cycle, but patients say they’re frustrated at the time spent correcting these errors—45% spend up to one month on the back and forth between payers and provider billing teams.Better medical billing software can automate claims management at the beginning of the reimbursement process and eliminate the traditionally labor-intensive processes plagued by human errors. Medical billing software can also make it easier for patients to pay and understand their coverage eligibility for fewer surprises after their care encounter.

This article discusses how healthcare providers can implement these tools and set the stage for a better revenue cycle, happier patients, and more efficient care delivery.

Common problems with medical billing

Experian Health’s State of Claims 2022 report showed healthcare denials increasing substantially each year. Some of the most common medical billing errors include:

  • Medical coding transforms a healthcare service deliverable into reimbursable revenue. Yet Experian Health data shows that 42% of providers say inaccuracies in coding reporting lead to frequent claims denials. Coding errors delay reimbursement and, at worst, increase the risk of health system fraud, abuse fines, or even impact patient care with an incorrect diagnostic code.
  • Patient information errors, including missing or incomplete prior authorizations, are among the top three reasons for claim denials. Even a misspelled name or date of birth can cause the claim to return to the provider for correction. Problems with outdated medical records and manual data entry exacerbate these issues.

While each provider and payer has unique claims denial numbers to share, Medicare reports that the average volume of errors is just over 7%. Yet providers can’t take all the blame for the volume of clerical errors given the complexities of ICD-10 requirements. Medical Economics explains, “The Centers for Medicare and Medicaid Services (CMS) announced 395 new diagnosis codes, 25 deletions and 13 revisions for the fiscal year (FY) 2024 ICD-10 CM code set.”

Medical billing software is critical for preventing healthcare claims denials by keeping up with these complexities and avoiding human errors. What can the latest round of automated, artificial intelligence (AI) powered software do for the average healthcare provider?

Prevent claims denials with better medical billing software

Experian Health’s Patient Access Curator solution heads off claims denials before they happen. The solution incorporates AI to improve the accuracy of claims management at patient registration and billing. The system leverages logic that returns multiple data points from a single inquiry in 30 seconds – streamlining benefits coordination, lessening patient identifier errors, and spotting “hidden” eligibility. Some of the benefits include:

  • Faster and more accurate eligibility verification – Legacy medical billing software operates from a clearinghouse model. However, these tools often miss active, billable coverage and require extensive manual workflows to edit claims and appeals. AI eliminates the standard by-hand workarounds correlated with traditional billing software.
  • Better coordination of benefits (COB) – COB denials are common in healthcare. Many patients do not understand the intricacies of government and commercial coverages and how they interact. Patient Access Curator can help. When integrated into the registration eligibility verification process, this AI-powered tool can lessen or eliminate COB denials by identifying hidden payer coverage requirements that outdated software cannot find. Additionally, the software can trigger automatic inquiries to third parties to verify active coverage quickly.
  • Streamlines MBI conversions – How much time do providers spend tracking down Medicare Beneficiary Identifiers during patient registration? The complicating factor is that MBIs change without warning; many patients and providers find out after the payor rejects the claim. Providers can eliminate this frustration by adding software that automatically updates MBIs in real-time. No more searching websites, calling patients—or reworking the claim.
  • Increases accuracy of patient demographic data –The quality of healthcare data can begin to erode at registration. Incorrect or obsolete patient data is a challenge for the entire industry. It makes sense that up-to-date, accurate patient demographic information improves their experience. Providers can eliminate obsolete or incorrect patient data with better medical billing software to lessen claims denials. Patient Access Curator automatically updates outdated information for cleaner claims and more accurate data.
  • Automates coverage and financial verification for increased accuracy – Patients and providers benefit from AI automation that accurately identifies payment details. The solution is particularly beneficial for spotting missed revenue opportunities for self-pay, unbillable, or patients with unspecified payer status records. Patient Access Curator also identifies each customer’s ability and propensity to pay, increasing the likelihood of successful revenue capture later while maintaining patient satisfaction and comfort.

Reimbursement accuracy, staff efficiency, and patient satisfaction all stem from better medical billing software. Patient Access Curator offers healthcare providers a way to turn claims management into denials prevention. These tools apply a proactive, preventative automated process with artificial intelligence to increase downstream revenue by reducing claims denials.

Experian Health, ranked Best in KLAS in Claims Management, Clearinghouse, and Revenue Cycle Contract Management for 2024, is the leading provider of technology solutions to improve healthcare reimbursement. Experian Health solutions have helped many healthcare providers obliterate claims denials.

In 2023, the organization acquired Wave HDC, an AI-powered healthcare data curation solution leveraging the latest AI technology innovations for a better revenue cycle. To find out more, contact Experian Health today.

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