Medical Billing Reconciliation is Snail-Paced: 3 Ways to Accelerate the Process

Many hospital systems today find themselves in a hybrid world of extremely advanced technology on the one hand (like robot-assisted surgery) and extremely manual processes on the other (like trying to accurately bill a patient after a robot-assisted procedure).

Just last week, in fact, I was talking with the Head of Innovation from a New York-based system who complained of exactly this disconnect. A patient can have cutting-edge robot-assisted surgery, but the robot can’t access that EHR before or during the procedure. And it doesn’t then transfer data about that surgery to the patient’s EHR without manual intervention.

Meanwhile, the billing department has to pull the insurance data the same way it did 15 years ago.

In other words, hospitals have more data than ever, but it’s largely siloed. And with every new machine or software or robot that’s added to the mix, the problem compounds. Data is neither shared freely within hospitals nor integrated between system participants.

This is becoming an increasingly expensive problem, particularly in billing departments. Hospitals have little choice but to keep hiring staff to work through the data deluge. That’s not sustainable. Luckily, the steps that will make billing reconciliation faster and more efficient will also lead to better patient care. Here’s how hospital systems can tackle the problem.


1. Solve Small Problems, Then Scale Up

Better connectivity and the ability to access patient information across the continuum of care could vastly improve the patient experience and make work more efficient for medical billing departments.

But it’s unrealistic to tackle the whole care continuum at once: ROI would be years away and hospitals would suffer from analysis-paralysis on where to start.

What works better: Identify a single, high-value opportunity for improvement. Maybe there's an insurance provider that covers 10 percent of your patients. Integrate patient data for that slice of the population in a way that reduces the billing team’s workload. Then, apply what you learn to a similar but larger problem – say, to the insurance provider that covers 50 percent of your population.

This approach lets you learn with small-scale problems. It’s a bit like hosting a dinner for 10 people before you host for 50. Figure out which order to prep food in, how to share the oven, what you can prepare ahead, etc., before you’re on the hook to feed a crowd.

As you move to different types of problems, you can use a similar framework for solving them. Outline the steps you’ll take, prioritizing the most valuable changes. To determine what’s most valuable, think about which changes are repeatable and which will reduce your billing team’s workload. 

Starting small also has the benefit of introducing changes to staff gradually, which can lead to less resistance as deep-rooted practices evolve. When you scale up to larger projects, staff will be confident in the new processes. And you will have some wins under your belt to support your ask for change.


2. Build Your Data Foundation

Regardless of what your initial project is, you’ll need a solid foundation of data to work with. In fact, creating that data foundation will likely be a key part of completing your initial project.

But I don’t recommend a pure-play attempt to organize your data as your first step toward improving billing reconciliation. It’s too big a project and too removed from tangible ROI. Instead, focus on organizing the data you’ll need for your first project. Learn from that process, and apply those lessons to your next project. 

Maintaining your data will be an ongoing process. Typical best practices to get started:

- Standardize and organize your data
- Define what good data stewardship looks like at your organization
- Establish data compliance policies for staff to follow
- Set clear data entry guidelines
- Invest in data literacy efforts for your teams

Better managed data will help you address urgent pain points like the ever-expanding burden of billing reconciliation. It also positions you to improve nearly every other aspect of operations.

Improving your data can make finding the answers to patient billing questions easier. But once you have that solid data foundation in place, you can also use it to create new efficiencies with technology like machine learning and AI. Imagine, for example, an AI tool that can analyze patient information and submit insurance claims in a specific format requested by a given payor while taking into consideration the minutia of negotiated rates and coverage of a given plan. It could save your billing department lots of time, but it requires a thorough, organized database to do its job accurately. 


3. Build Connections Across the Care Continuum

Getting your data in order will enable you to scale your solutions not only up but also out. Connecting with your partners’ systems will maximize your ability to scale and reduce time spent on reconciliation. 

Much of the healthcare industry functions within silos. Hospitals, insurance providers, pharmacies, and medical supply distributors all have their own systems. If we can break the barriers between these system participants, we can make medical billing reconciliation more efficient and deliver better patient care. 

Consider the time your billing department spends comparing billing records and insurance claims to identify discrepancies, for example. If the insurance provider’s data was integrated with your hospital’s data, this process could be automated. AI tools could scan records and identify inconsistencies with far less effort than it takes your staff to do the same work. 

If you could improve your ability to serve patients with half the number of billing department staff, what investments might you have the capacity for?

The possibilities are tantalizing, not least because automating repetitive work frees up your employees to develop creative solutions they don’t have time to consider today. At first, you’ll see the benefits of improved data within the medical billing department. But eventually, the benefits will spread throughout your organization.   

Faster Medical Billing Reconciliation Leads to Better Patient Care

Improved billing reconciliation will lead to faster, more accurate payments for hospitals and less need for massive billing departments. The data improvements required to streamline billing reconciliation will also lead to better patient care. 

For example, one of the largest hospital systems in Latin America undertook digital transformation work that led to clean, unified data. Now that it has this visibility throughout the system, it can do things totally unrelated to the original project, like improve patient care protocol: physicians can adapt treatments set in the wealthiest region of a country so they work for the realities of access in poorer areas. Now care is better for everyone.

None of the steps to accelerate medical billing reconciliation are quick fixes, and you won’t get to a “perfect” end state. But just as with managing patient health, steady, consistent improvements will ripple outward and improve quality of operations for your organization and quality of life for the people you serve.

Luiz Cieslak

SVP, Head of Healthcare & Life Sciences