Building a Robust Commercial Patient Billing Process

Inherent Problems of Commercial Patient Billing

In recent times, there has been a surge in the number of health plans available to the common man in the US. New commercial insurance companies have come into being, bringing with them health insurance policies of all shapes and sizes to suit every kind of budget and requirement. Healthcare service providers dotting the US landscape are regularly frequented by patients carrying coverage under either under federal plans such as Medicare and Medicaid, or private, commercial payers, or a combination of both.

This motley scheme of affairs poses a peculiar difficulty in many cases. An apt example may be seen in the case of Federally Qualified Health Centers (FQHC). These specialized clinics operate chiefly on an outpatient mode and cater to patients from local communities covered under Medicare and Medicaid. However, they also witness a regular influx of patients who qualify for commercial patient billing. While most FQHCs have highly streamlined billing processes for patients covered under federal health plans, they tend to falter in cases involving commercial payers. This is primarily because commercial patient billing brings with it a kind of variety and immensity that the usually small billing desks of FQHCs find difficult to handle.

Building a More Efficient Billing Process

With a view to building a robust and efficient process, a growing number of FQHCs are outsourcing their commercial patient billing tasks to specialized billing agencies. It is pertinent to bear in mind that FQHCs offer a wide range of healthcare services that include (but are not limited to) preventive health services, dental services, mental health and substance abuse services, transportation services necessary for adequate patient care, hospital and specialty care. For patients carrying commercially available coverage and availing such services, taking care of the varying reimbursement caveats as required by different payers can be a really daunting task.

This is where professional billers and coders can come to the rescue! When done with some degree of strategic planning, outsourcing of billing operations to an external billing partner – especially if that partner is located in a foreign country where the cost of labor is cheap but the local talent pool is plentiful – can bring about fantastic savings for the provider. Moreover, FQHCs can reap rich benefits from an outsourced scenario by instantly improving the overall efficiency and effectiveness of their billing operations, thereby leading to fewer errors, shrinking ARs and increased collections.