The medical billing process has traditionally been a convoluted process, steeped in paperwork and the potential for inaccuracies. It’s no surprise then that healthcare providers are increasingly looking to digitise the process as much as possible.

On the one hand, such technological innovations have the potential to remove a great deal of frustration and annoyance from the process – for patients, healthcare providers, and of course insurers. But at the same time, implementing such all-encompassing systems can be challenging, and needs to be managed effectively, given the high costs involved.

Electronic health records

A key technology that is at the heart of how healthcare providers are digitising their billing process is the electronic health record (EHR).

“These systems seamlessly integrate patient information, treatment procedures, and billing codes,” said Cristiano Flor, International Client Department Coordinator at Grupo HPA Saúde – Madeira. “By digitising patient records and billing data, manual entry errors are minimised, ensuring accuracy and expediting the process.”

Dr Maria Cecilia Aponte, International Business Director at The Panama Clinic, agreed with Flor about the importance of EHR systems. She explained that “by capturing data in a structured, digital format, EHRs facilitate more precise coding and billing, reducing the errors associated with manual document transcription”.

Rebecca Wyer, Director of Data and Technology at AXA – Global Healthcare, agreed that from her company’s perspective, organising data in a standard, structured fashion was hugely beneficial.

“We are working closely with our strategic technology partners to improve how we ingest and analyse data we receive in medical bills,” Wyer explained. “Key to our success in this space is being able to structure the data in a format that allows artificial intelligence (AI) models to run effectively.”

Billing software

Beyond this, another technology Dr Aponte said was contributing to greater billing accuracy was the adoption of “specialised billing software and revenue cycle management (RCM) systems” capable of “automating and streamlining various billing-related tasks, such as claim generation, submission, and tracking”.

Healthcare organisations may also try to pass some costs directly on to patients

Flor agreed that such electronic billing systems could be hugely beneficial, again improving process speeds and reducing errors. However, he added that to ensure the effectiveness of these processes, such digital platforms should be “equipped with built-in validation checks to ensure claims comply with regulatory standards and accurately reflect services provided”.

While both EHR and RCM systems are effective in their own right, Dr Aponte explained that by integrating such systems with each other, and with other healthcare IT systems, a significant amount of clerical work can be automated, and manual data entry “minimised”.

AI and machine learning

Flor added that HPA is also investigating – and investing in – the use of other advanced software capable of “analysing medical documentation and automatically assigning appropriate billing codes”.

Such technology, often utilising AI and machine learning algorithms, is becoming increasingly common, noted Dr Aponte, and could allow healthcare providers to be more proactive in preventing potential issues from developing.

“These advanced technologies can analyse vast amounts of clinical and financial data to identify patterns, trends, and anomalies that may impact billing,” she explained. “For example, AI-powered predictive models can help patients at risk of claim denials or undercoding, allowing providers to intervene proactively and address potential issues before they escalate.”

The initial cost

Despite the obvious benefits for both hospitals and insurers of implementing new technology to improve the billing process, such innovations are not without their drawbacks. One major hurdle, Flor acknowledged, is the initial cost.

“While the implementation of new technology for payment systems can yield significant benefits in terms of billing accuracy and efficiency,” he explained, “it also incurs costs for healthcare organisations like HPA. The initial investment required to purchase and implement coding software, electronic billing platforms, and other technological solutions can be substantial.”

Despite this, added Flor, “HPA recognises that the long-term benefits ... outweigh the initial costs of technology implementation”, it being a valuable tool that not only streamlines the billing process but also “enhances transparency”, while “compliance afforded by these technological solutions can mitigate the risk of audit findings and regulatory penalties”.

Like Flor, Dr Aponte acknowledged that the implementation of new technology to improve the billing process could be costly – with a range of factors affecting just how expensive implementation can get.

“Costs can vary significantly depending on … the complexity of technology, the scale of implementation, and the specific needs of the organisation,” she explained. “For example, small physician practices may opt for cost-effective cloud-based EHR and billing software solutions, while large hospital systems may invest in enterprise-grade systems with advanced customisation and integration capabilities.”

Other expenses

Flor also noted that healthcare providers looking to implement such systems must also be aware of the “ongoing maintenance and subscription fees associated with these systems”. Such costs can be easy to overlook in more prosperous times, but can also be a difficult financial burden for healthcare providers if revenue shrinks.

Dr Aponte added that on top of regular maintenance, software licensing and subscription costs, other expenses include “hardware acquisition and installation costs, customisation and integration expenses, training and support fees, and upgrade costs”. These expenses represent a mix of significant upfront and ongoing costs.

In particular, she argued that allocating sufficient funding for training is “crucial” to ensuring “healthcare professionals understand how to navigate the software, document patient encounters accurately, and code procedures and diagnoses appropriately”.

Absorbing the costs

While it’s undebatable that implementing new technologies represents a significant investment, the question of whether the cost of new billing-related technologies gets passed on to customers and insurance firms is complicated.

“The answer is not straightforward, and depends on various factors,” said Dr Aponte. “In some cases, healthcare providers may absorb the upfront costs … as part of their operational expenses.”

Alternatively, providers’ costs may ultimately be recouped through adjustments to reimbursement rates from insurers, or through increased charges for healthcare services.

Doctors play a crucial role in the successful adoption and implementation of these solutions

Dr Aponte added that healthcare organisations may also try to pass some costs directly on to patients through higher out-of-pocket expenses or copays – an approach that may be more common in settings where patients have greater responsibility for their medical costs, “such as high-deductible health plans or fee-for-service arrangements”.

“Similarly, insurance firms may adjust their premium rates or reimbursement policies to account for the increased costs associated with the providers’ adoption of new systems technology. They may also incentivise or penalise providers based on their use of electronic billing or other technological advancements that impact claims processing and reimbursement efficiency,” said Dr Aponte.

Flor agreed, adding that “in terms of cost distribution”, his own company aims to “balance the financial burden of technology between the organisation, its customers, and insurance firms”. He affirmed, however, that “HPA remains committed to ensuring that any cost increases are justified by the value and benefits delivered to patients and payers”.

The human factor

While digital tools can radically improve the billing process offered by healthcare providers, the successful integration of new technology relies heavily on the engagement of frontline medical staff such as doctors.

Flor said that, at HPA, hospital administrators “work closely with physicians to assess their needs and preferences” when adopting and implementing new technology. He added that ensuring that staff knew how to use new tools was also vital.

“To facilitate engagement, HPA provides comprehensive training and support to doctors on the use of new solutions,” he explained. “Whether it be coding software, EHR systems, or electronic billing platforms, physicians receive tailored training sessions and ongoing assistance to ensure they are comfortable and proficient in utilising these tools in their daily practice.”

Training can involve in-person sessions and workshops, online tutorials, or ongoing technical support and troubleshooting assistance.

Flor recommended that hospital administrators and doctors should engage in an open dialogue to “solicit feedback and address any concerns or challenges related to new technology adoption”. By involving physicians in the decision-making process, he added, “technological solutions can be aligned with clinical workflows and meet the needs of frontline healthcare providers”.

Dr Aponte agreed, adding that “by involving doctors early in the process, administrators can garner buy-in and support from frontline staff, increasing the likelihood of successful implementation and adoption”.

“Doctors play a crucial role in the successful adoption and implementation of these solutions, as they are directly involved in patient care delivery, and are key stakeholders in the healthcare ecosystem,” she continued. “Once new solutions are deployed, doctors … incorporate them into their daily practice routines. This
may involve using EHR systems to document patient encounters, order medications and tests, and review clinical information.”

For Dr Aponte, a mixture of “effective communication, training, and support” is essential to ensuring that doctors “leverage new solutions to their fullest”.

Wyer noted that while most of the healthcare providers AXA – Global Healthcare works with “are using some level of digital medical billing system … the level of adoption and effectiveness of these products is varied”.

She agreed that while “digital literacy across healthcare professionals” was a key factor in how useful such systems were, other factors are typically at play. These include the degree of government or regulator involvement, and the general maturity of the country’s EHR – in particular, the level of standardisation.

“Where countries have standardised codes for medical billing – such as US and UK – this process is significantly streamlined,” said Wyer. “However, as an international business we have additional complexity to navigate.”

Conclusion

There is an array of technologies that can improve the hospital billing process – whether that is through greater medical record accuracy, the ability to automate billing processes, or the ability to predict when a patient is at risk of a denied claim. Such systems are especially effective when joined together, allowing data entry to be minimised as much as possible.

However, it is also clear that such innovations can have knock-on effects. This includes, ironically, the potential for more expensive medical bills, if healthcare providers choose to pass on some of the costs of implementation and maintenance to insurers and patients.

Additionally, while there is naturally a great focus on ensuring that new solutions are introduced in a cost-effective way, healthcare providers should take care to ensure that their staff are trained to use them to their full potential.

Ultimately, like any investment, the digitising of hospital systems requires careful consideration of the benefits and costs, as well
as an understanding of how these decisions translate to the real world. When done in a rational, well-planned manner, such improvements can be a boon for all parties – patient, healthcare provider, and insurer.