The challenges of medical billing
Over the past number of years, I have spoken to many people involved in medical billing across different hospitals in Ireland and more recently in the UK. The common feature of these conversations is that medical billing is a massive challenge to finance teams in hospitals. The size of this challenge has been estimated to amount to a 6-9% leakage of revenue for hospitals. The reasons resulting in this huge leakage are multiple but there three components I would point to.
Patients are living longer and though Ireland is one of the younger nations in Europe, our population is steadily growing older. An aging population will inevitably continue to increase the strain on healthcare services with more chronic and long-term illnesses as the population gets older. As complexity in the care of patients increases, so does managing the healthcare billing that pays for this treatment. Patients appear multiple times for varying treatments and from different doctors. The existing systems can’t cope with the sheer volume of information captured about a patient and required for easy billing.
Medicine has changed dramatically since I started. A significant portion of a doctor’s career is spent keeping pace with change by attending seminars and reading up research papers. Even in the last year, the mRNA vaccines were a flagship moment in healthcare with considerable long-term implications. There has been a proliferation in MedTech and hospitals are grappling with these changes. Just as changing demographics present a challenge to hospitals when it comes to billing so too do the breadth of ever increasing numbers of new treatments and systems.
Changing requirements with insurers
Insurers are the “dance partner” of hospitals when it comes to medical billing. Insurers are grappling with the changing landscape of healthcare as much as hospitals. A lack of trust in the current system stems from the inaccuracies that lead to over or undercharging meaning insurers have to devote huge resources to be sure that fraud is out ruled they are paying the correct amounts for their members’ care. This has created additional requirements for hospitals and each insurer has its own individual requests of providers.
Given the above trends, Hospitals will soon have to “grasp the nettle” and work with technological solutions that are designed to alleviate the inexorable growth in work currently being felt in claims teams.
Hospitals are losing 6-9% of their revenue due to leakages in the billing process. MedoSync stops these leakages by creating the invoice in real-time and ensures hospitals get paid in full.
I am taking more time for reflection and writing up posts related to MedoSync’s area of expertise: medical billing, healthcare, technology and being a start-up in that ecosystem.