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POSTS BY TAG | patient experience

Ensuring a clean claim to avoid denial


Here at pMD, our passion is applying technology to improve health care delivery and billing. Natural language processing, often abbreviated as NLP, is a class of technology with enormous potential for integrating into all aspects of health care. We’ll discuss the current state of NLP, its potential use in health care, and the challenges that lie ahead.

What is Natural Language Processing (NLP)?


To understand Natural Language Processing (NLP), we must first understand the definition of natural language. Put simply, natural language is anything that people use to communicate with each other. This includes spoken language as well as written forms of language such as letters, emails, and text messages.

Natural language processing is then exactly what it sounds like: processing natural language for useful insights. In other words, NLP can be thought of as a pipeline. The beginning of the pipeline starts with the unprocessed natural language, and the product of the pipeline is the output of useful information for interpretation or analysis. The difficulty of NLP lies in the middle stage of this pipeline: engineering algorithms that are capable of processing the nuance of natural language into useful insights. As this is such a broad definition, everything from the humble autocorrect to sophisticated products such as Siri and Google Translate can be categorized as NLP.

Current Applications of NLP to Health Care


Current applications of NLP to health care remain limited but promising. One type of NLP technology is speech-to-text. Providers speak into a dedicated device or mobile app, which records their voice. Then, either a human scribe or an automated voice recognition algorithm will transcribe their spoken words into text. This allows them to “write” documentation or messages much faster than typing. A natural evolution of this technology is the digital scribe, a program that not only records what the provider is saying but also analyzes entire provider-patient encounters to generate a condensed report.

On the documentation and billing side, NLP has found applications as well. One major area of application is EHR verification. Algorithms can scan through clinical notes and attempt to determine whether the provider’s documentation is sufficiently detailed. On the billing side, computer-assisted coding can perform a similar function by scanning documentation for billing-related information. These programs can help billers faster parse through long notes and suggest potentially billable codes.

How do these applications benefit health care? Firstly, they have the potential to provide a better patient experience by freeing the provider from staring at a screen. A fully operational digital scribe would handle documentation, allowing the provider to focus on the patient. Additionally, NLP products can streamline practice workflows, whether on the clinical or billing side. EHR verification can automatically flag missing information for correction, while computer-assisted coding can accelerate the billing process.

The Road Ahead for NLP in Health Care


With much of NLP, the challenge lies in finding ways to analyze the nuances of natural language with algorithms. Although great strides have been made in improving machine understanding of natural language, there are still numerous problems with reliability as well as concerns about cost and interoperability. Ironically, many of the tasks described in this post would be relatively simple, albeit tedious, for somebody with medical knowledge. With NLP, the hope is that technology can offload the burden of these tedious tasks and allow clinicians, billers, staff, and patients to focus on health care.

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrybilling servicestelehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.
Patient experience and revenue cycle management


Successful revenue cycle management, or RCM, can mean a lot of different things: financial stability, increased revenue, and reportable data. From submitting claims to collecting payments to reporting, practices rely on this process and its resulting data to help them identify trends and make important business decisions. But there is one essential factor to the success of RCM that is often overlooked and that’s the patient experience. We don’t inherently lump patient experience with financial upside, so why is it so important to RCM?

The patient experience cycle


When we think about the patient experience, we often limit its range to the visit itself or the care received. But what we don’t realize is that, more or less, there are multiple points of interaction outside of just the face-to-face encounter with a provider. From the time an appointment is scheduled to when the patient pays their bills, the quality of the patient experience depends on how smooth the process is at every point of the cycle. 

The patient payment process can be a particularly challenging one to navigate for many reasons. In some instances, patients are faced with paper statements that may arrive late in the mail or are possibly overlooked. Then, the patient would still be required to call the doctor’s office to make the actual payment via credit card or worse, would have to mail a check. Now imagine being able to receive statements via text or email and having the option to pay directly from there, or even at the point of service. Patients aren’t concerned with whether or not the practice is using an in-house versus outsourced biller nor do they really have visibility into such things on the backend. So, when it comes time for a patient to pay their medical bills, if the front end process is disorganized, unclear, or difficult in any way, you can bet the patient's experience suffers and the onus of that bad experience often falls squarely onto the practice, undoing all the hard work and thought put into providing great medical care.

Keeping the patient experience top-of-mind


Every step of the patient cycle plays a key role in providing a positive patient experience - appointment reminders, patient intake, gathering financial and insurance information, the encounter with the provider, the payment process - all of these combined make a strong case for a good experience, should everything go smoothly. Things like no-shows due to a lack of appointment reminders or sending paper statements that cause delays in timely payments can hinder not only a good patient experience but also the chances of collecting payments in a timely manner, if at all.

As a practice, it’s easier to provide that seamless experience when everything you need is in one place. At pMD, we care about what you care about. We’re a team that’s invested in the things you’re invested in. So naturally, your patients are our top priority. Our revenue cycle management service allows you to provide that top-notch patient experience while also seeing your revenue increase. Let us take care of the administrative work so you can focus on what matters most.

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To find out more about pMD's suite of products, which includes our charge capture and MIPS registrybilling servicestelehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.


Claim denied. Ugh! These are two words that make all those involved in the health care revenue cycle cringe. Unfortunately, claim denials are very common, costly, and time-consuming to correct. However, there are strategies to avoid them, with the potential to significantly increase your bottom line and decrease your revenue-related headaches. We’re going to talk about one of those strategies here — real-time eligibility. 

Why Are My Claims Being Denied?


Eligibility verification is one of the first phases in the revenue cycle and by far the most significant. Did you know eligibility issues are one of the top five reasons claims deny? In fact,  nearly 24% of claims submitted are denied for eligibility and registration issues, such as the patient not being eligible for medical benefits on the date of service, or having incorrect demographic information, like date of birth or a misspelled name. 

The eligibility verification process is directly linked to claim denials which can have a variety of unwanted consequences. This includes a hike in the number of days in A/R, an escalation in write-off rates, a standstill of cash flow, inflated costs to collect, and most importantly, delays in a patients' access to treatment. The process of verifying eligibility needs to be both efficient and accurate in order to determine the responsibilities of both the payer and the patient.

How Do I Make Sure My Claims Aren’t Denied?


Most claim denials are avoidable, in fact, 90% of them could be avoided. Research also shows that of those denied claims, approximately 60% of claims are recoverable, meaning they can be corrected and resubmitted for reimbursement. 

This sounds pretty good, right? Well, the reality is that a whopping 65% of denied claims are never reworked, which translates to a huge loss in revenue. The remaining claims that are reworked can be a drain on resources when factoring in both time and overhead costs. The average cost to correct and resubmit a denied claim can range anywhere from $30 - $125 per claim.

By implementing the right tools and processes, such as checking real-time eligibility, the likelihood of having your claims denied decreases significantly. By simply using real-time eligibility tools, you’ll be able to increase the number of  “clean” or error-free claims submitted,  tackling a number of the top reasons claims are denied, such as eligibility, no authorization, or being covered by another insurance plan.

What Is Real-Time Eligibility?


But what exactly is real-time eligibility, and how do I use it to my advantage?

Real-time eligibility is a software tool that allows medical staff to electronically confirm a patient’s insurance coverage by interfacing directly with the insurance carriers. This instant eligibility check provides an up-to-date overview of the patient’s coverage and plan benefits. Real-time eligibility can answer important questions such as if the insurance policy is active, the start and end dates of a policy, deductible amounts, copay coverage, and if prior authorization is required. Verification checks can be done at the time of the patient’s appointment, or even prior, which not only saves both the staff and patient time during check-in but also provides a clear understanding of both the provider and patients’ responsibilities.

Real-time eligibility benefits all those involved in the revenue cycle management process. For example, the amount of time staff spends checking and verifying a patient’s coverage is reduced significantly, as it eliminates back and forth phone calls, and the need to check multiple systems in order to verify coverage. Additionally, verifications are saved to the patient’s record, which provides an audit trail and proof of insurance coverage. Plus, it makes it much easier to submit clean, error-free claims, which facilitates faster payment and improves cash flow, which leads to increased provider satisfaction. Let’s not forget about the most important part of the revenue cycle, the patient. Being able to communicate to the patient their financial responsibility prior to, or at the time of service, makes for a much-improved patient experience.

Claim denials are preventable when identified and addressed early in the revenue cycle process. By implementing real-time eligibility, you can decrease the burden of claim denials, and in turn, enhance revenue, improve the overall patient experience, and let the provider focus on what matters most — patient care.

Learn About pMD Medical Billing & RCM Tools & Services


If you are interested in learning more about pMD’s billing and revenue cycle management services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

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Improved medical billing and payment system boosts patient satisfaction

Everyone who has received medical care in the U.S. has experienced the complex system built around paying for the care you receive. From complicated insurance types to delayed and unforeseen bills, many agree that the financial burdens that come from U.S. health care are the toughest to swallow. The system, in all its complexity, is difficult for a reason. The negotiations that take place between insurance carriers and medical billing teams determine the amount that each patient has to pay on a case-by-case basis. The limited forms of payment exist for the security of the patient and the protection of their private health information. But is there a way to improve the patient experience when it comes to paying for medical care?

Providing Patients Cost Estimates & Easy Way to Pay for Medical Care

In 2018, in a survey conducted by HIMSS Analytics, researchers found that 68% of patients would be more likely to return to a practice for future care if a cost estimate was available to them at the time of service. It was also found that 75% of patients wished they could keep a credit card on file for any balances that come up during their care. Simple fixes go a long way towards improving patient retention and driving practice growth. The easier you make it for your patients to pay for their care, the more money you are likely to receive.

Benefits of Providing Patient Care Cost Estimates

Cost estimates of patient care are one of the largest things a practice can do to make patients feel more financially comfortable while navigating their episode of care. An unforeseen bill, or one that is larger than expected, can unsettle a patient and may lead to higher rates of uncollected revenue. Upfront estimates provide peace of mind and allow patients to make informed decisions about the care they are receiving. The HIMSS Analytics survey found that 46% of patients also said they would be more likely to pay a significant portion of their bill upfront if an estimate were available. This simple step can create massive benefits for both practice and patient by keeping all parties informed and engaged throughout all aspects of care.

Patients Prefer Modern Medical Billing & Payment Solutions

The growth of consumer culture in health care also means patients want to be able to pay for their visits using modern solutions. Scheduling apps and HIPAA-compliant payment portals are growing in popularity and patients are responding positively. By allowing patients to pay online, not only is the patient experience improved, but the providers will receive reimbursement for their work faster than paper billing alternatives. A 2016 survey by Aite Group shows that 56% of all bills that year were paid online, while 77% of health care practices specifically use paper billing systems. This comparison shows that the needs of the 50% of patients that state they would prefer online or paperless medical billing are not being properly addressed by their health care providers.

pMD Charge Capture the First Step

Tools like pMD® Charge Capture™ allow providers to capture their charges in real-time and reduce billing lag. These workflow improvements are the first step to providing patients with quick and accurate estimates of the money they owe and create more actionable opportunities for providers to maximize their revenue while driving patient growth. It all stems from the patient experience.

Related Articles:
What to Look For When Evaluating Charge Capture: Charge Lag Statistics
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To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.


 

Telehealth, or telemedicine, has existed for years, but with the emergence of COVID-19, the relationship between telehealth and the health care industry was transformed practically overnight. For most practices, COVID-19 catapulted telehealth from a long-term possibility to a complete and immediate necessity. According to AARP, demand for telehealth surged 1,000% by mid-April when compared to the time period before the emergence of the COVID-19 disease. This change came with a need for providers to train staff, evaluate software vendors, and devise new workflows to support telehealth. The patient side of the health care industry was equally disrupted, with individuals no longer able to continue their care in person. While some patients had experience with video conferencing through their employers or through FaceTiming family and friends, many were thrown into a new world of installing software, attaching webcams, creating accounts, and setting passwords.

Supporting patient adoption


At pMD, we have always been dedicated to easing the burden of learning or implementing new technology for both practices and patients. We have decades of experience working closely with practices to customize our software to meet their needs. The pMD team trains practice staff, provides 24/7 technical support, and implements our software in a way that best fits each practice’s existing workflow. The same approach is taken with patients using our software. We give them direct access to our knowledgeable employees who can help them work through even the hardest technical issues, we train them to use the software when needed, and we allow them to accomplish their telehealth encounter using the device and process that makes the most sense for them.

While pMD approaches helping practices and patients in a similar way, patients' needs differ in many ways. Individuals have a wide range of experience and comfort with technology. They use different software and hardware from many practices, sometimes using phones or computers that can be up to 15 years old, and they may be running software equally as out-of-date. If an individual encounters issues with software compatibility, they don’t have an IT department to contact in the same way many practices do. At pMD, we do our best to support every possible software and hardware configuration on laptops, desktops, phones, and tablets. We also integrate all options in a seamless manner, allowing for use of a web browser or a native app. 

The seamless patient experience


On the software engineering end, this involves addressing a complicated mix of all possible configurations with special attention paid to potential issues and workarounds. But, on the patient’s end, it simply looks like a functioning telehealth encounter that is as easy to use as clicking or tapping on a link or on a push-notification. The goal is to have the patient able to interact with telehealth in a manner that fits smoothly into their daily life. Patients can move easily from texting their children one moment to tapping on the text-message link telehealth visit the next. Users can pause their twitter use to tap a push-notification alerting them that their telehealth appointment is about to begin. Or, they can switch from emailing colleagues to starting their telehealth encounter by following a link sent to their inbox. And it all just works!  Nonetheless, if there are questions, as always, a friendly pMD employee is always ready and waiting to help with any issues that may arise. Want to learn more about pMD telehealth? Contact us! We'd love to hear from you.

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.