Medical billing, a world of hurt: Error-prone system is a headache for insurers, doctors, patients

National reports show that 60% of medical bills created have errors in India. The world of billing problems is as vast as medicine itself. Many frequent complaints from patient side are: receiving double billing for the same treatment, being billed for the wrong treatment, getting a bill for unexpected costs etc. Problem comes because of human involvement in the entire process before billing creation. It’s generally an estimated that approximately  10-15 people are involved in generating a single patient bill, from the receptionist who collect the personal information from patients, doctors and nurses who treat the patient, pharmacy , lab and housekeeping who provide added services to the patient. So from a billing perspective it becomes very difficult to bill for 50 items in a single time.

Here are some examples of scenarios that happen all-too-often while creating billing:

1) Medical Error #1: Billing for procedures that were not performed

An old man received a bill for his annual physical examination. The charges included a line for a pap smear, which even general people know is a test that is only for women. Had he reviewed the bill right there at the time of discharge?  That charge would have been removed before the claim was ever sent in to the insurance. No generally people have tendency not to view at the same time while it gets created. When same bill will be produced for claim settlement and it won’t get reimbursed then the person will blame to hospital

2) Medical Billing Error #3: Duplicate charges

Hospital bill that itemized 55 of the same item at Rs.300 each. This item is something that no one could have done to them 55 times in the period of a four-day hospital admission. Can you make any guess? We're talking about a urinalysis process. Not only they charge very high, but the number of laboratory tests just didn't make any sense were done. If this patient had ever requested and had a glance of the bill, I'm pretty sure she would have picked this up.

3) Mistake #3: Not asking for itemized statements and then reviewing it

The best way to avoid medical bill errors is to make sure that the charges are correct. While no one expects you to be an expert in medical terminology but by requesting and reviewing a detailed itemized statement following every episode of care provided, you can easily avoid some of the general problems. Always take the time to ask for and look at an itemized bill. 

DocEngage provides complete itemized statements at the end of episodes what you request from the hospital at the checkout window.

DocEngage now has advanced billing features!! It is aimed at simplifying the billing process for doctor, concern staff and the patients. DocEngage provides benefit for doctors and concern staff in following manners:

·        Provide complete track of billing done for a particular patient

·        The ledger will give a complete overview of the total billed amount and total amount paid

·        Provide complete  track of the due amount

·        Settlement against advance payment can be made.

·        Payment can be made by the patient for a single invoice generated multiple times

·        Any time payment can be added

·        Provides notes option to write information related to the bill

·        Electronic tracking of payments

·        Doctor Will have a track on the revenue generated by him

·        Through care plan he/she can have a track of how many procedures has been completed

·        For how many procedures performed invoice has been generated

·        Transparent payment process

The Relationship between Computerized Patient Record Use and Quality Of Care

There is unanimity that widespread adoption of health information technology (IT), in particular computerized patient record, will result in increased efficiency and improved patient care. Computerized patient record is an evolving concept defined as a collection of electronic health information about individual patient or populations. It is a record in electronic format that is capable of being shared within across different healthcare providers, by being embedded in the network.

The main constraints in adopting computerized patient record are the physical barriers  and impact on the patient-doctor relationship that could result from the use of computerized patient record during the consultation. Initially there will be resistance in adopting electronic health record system but once doctor will expose the benefit of electronic health record, they will feel a need for an information system.

Computerized patient record helps in presenting  patient-specific information in the form of assessments or recommendations, or alerts or reminders during consultation. Computer based patient record system is designed to be used by care providers as a direct aid in clinical decision- making. In current scenario medical information required for clinical decision-making has increased; but  the accessibility of health data is still poor, resulting in inappropriate decisions and medical errors.

To increase the accessibility and management of patient related health information the use of electronic health record should be promoted. The first electronic health record will be used for the management of patients and collecting medical information.

Medical information is conceptually organized the patient’s paper medical record, and combine clinical and therapeutic  patient history. Computerized patient records are designed to be used directly by doctors during consultation and to provide online information and messages to help doctors in their practice.

The aim of DocEngage ( An Electronic Health Record) is to offer support in clinical decision-making, to increase coordination among health care providers, and to promote the correct care, thereby improving quality of care. The aim of DocEngage is also : to decrease the time duration for retrieval of medical records, allowing many care providers to have simultaneous access to the same patient medical record; to improve data confidentiality; and finally to collect routine data related to patient.

DocEngage increases quality of care by followings:

1) By providing timely access to patients’ related health information

2) By tracking patients over time of period to ensure that they receive accurate care

3) Helps in decision support-support  mechanisms to reduce medical errors

4) Provide accurate and complete data

5) Improved knowledge of patients’ medical history

6) Better Medical Examination

Health Care System: How to Nurture a High-Performance Medical Group of India using EHR

Before we review what it takes to operate a high-performing health care system, let’s start with some fast facts related to India:

Total number of doctors registered (allopathic): Approximately 8, 56,065 (Till 31^st July, 2011)

Total number of AYUSH Doctors (Ayurveda, Unani, Siddha, Naturopathy, Homeopathy): Approximately 7, 121, 21 (Till 31^st July, 2011)

Total number of dentist registered: Approximately 11, 8000

Hospitals: 15,393

Total no. of licensed Blood Bank: 2445

Exactly who is leading and managing this healthcare system fiercely independent collection of practices and doctors? Are their incentives now aligned with those of the hospital or health care system with whom they are working?  In addition, does this structure address the medical group constituency?

Very Important questions: While Indian health care currently trails nearly every other industry in innovation. We can see the accelerated growth in Indian healthcare. Government expenditure has also increased over last period. We are just beginning to see a wave of innovation the likes of which our industry has never seen: As innovation, we can see Ambulatory Surgical or Emergency Centers, Retail clinical chains especially in dental. All that has changed, and even “day care and hospital at home” facilities are demonstrating improved patient satisfaction and better outcomes.

Each of these new models is for caring about patients in the most cost-effective way. In addition, to succeed, each of these new models requires highly coordinated networks among high performance medical groups.

So how does a healthcare system transform a collection of independent practices into a high-performance medical group?

The solutions for transforming healthcare are followings:

1. A Clinical collaboration allows easy access, secure sharing and integration of clinical data of patients across a variety of platforms in a patient-centric care. This facilitates both storing of clinical data in various formats like in image, PDF, Word etc. and sharing this with other doctors. DocEngage helps in storage of various clinical records related to patients and sharing with other practioners.

2. An analytics service to develop both clinical as well as operational insight. Only Visibility is not enough. Now hospitals/clinicians need access to real-time analytics and dashboards that help them to understand revenue drivers and helps in decision-making at the point of care. DocEngage provides real time analytics and dashboard which gives an insight of revenue drivers and makes decision making more evidence based

3. Workflows that guide action to the right care provider at the right time. DocEngage helps in managing the workflow in easier manner and supports care provider by providing evidence material required for giving right treatment to patients. Evidence based material includes all patient’s assessments forms, investigations with impression, previous medications list, previous clinical notes and history related to perticular patients.

DocEngage is uniquely positioned to deliver above three solutions to health care systems. Here are a few examples of the advantages the DocEngage

Smart, comprehensive and intuitive access and helps in sharing of information—regardless of platform across the entire continuum of care;

• Provides real time visibility across the care providers network
• Rapid deployability, at one time more than one care center can be managed within single Organisation without any difficulties
• Financial efficiency, no software installation and server maintenance cost
• Helps in providing the right information to the right person at the right moment of care

DocEngage: Improving Care and Revenue through Patient Communication

Operating a small clinic in today’s economy is difficult. To provide high-quality medical care requires financial strength. Most of the  physicians are ill-equipped to survive in a very tough business environment in our country. They spend years training to take good care of their patients, but they have no idea to run a practice effectively. How can they best improve practice management, Patient Communication, delivery of care, financial health … all at the same time..

What is mainly required to make it all work?

A stable clinic needs to do two things : Maximize revenue and  control costs

In today’s world, small practices must also continually look for ways to increase their  revenue.

Controlling costs is actually very difficult but it can be managed with the help of the right stuff. An added challenge is with maximizing revenue is to improve care.

DocEngage helps small clinic in controlling costs and maximizing revenue by reducing errors during care and continuously retaining patients.

So, how DocEngage helps in increasing their bottom line with fixed reimbursement rates and overhead?

By increasing patient flow through their clinic. By two ways  this can be accomplished: 1. By gaining new patients; and 2. By increasing the number of visits from existing patients.

DocEngage helps in a continuously improving patient flow by increasing more communication between doctor and patient. It helps in seeing patients more often, which is not only financially rewarding, but it also helps in promoting better care. It works on the principle of maintaining a relationship with the patient, when they are healthier rather than when they are sick.

Let’s help in  getting healthy patients into the clinic and keeping them healthy.

DocEngage helps in patient communication, which can be a great driver for both health and revenue. It helps in sending e-mail to patients, to remind them about routine health maintenance visits. It also helps in sending reminders on the basis of age, gender and disease.

With these automated reminders, It helps in increasing scheduling  and does “the required thing” by improving care for a specific patient at-risk and general patients.

The next step-when DocEngage enables to see patients. Here is how it does: When a patient checks out, if his/her follow-up appointment is not made on the spot, DocEngage will automatically send reminders for the next recommended visit.

DocEngage helps in providing good care as well as financial stability, together.