Bulk billing and its impact on your health-based business

Medical billing is an integral part of healthcare businesses. It involves preparing claims and submitting them to insurance providers to reimburse practitioners and healthcare businesses for their patients’ services.

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A brief overview on medical billing

A brief overview on medical billing

Medical billing is an integral part of healthcare businesses. It involves preparing claims and submitting them to insurance providers to reimburse practitioners and healthcare businesses for their patients’ services. The financial reimbursement comes through insurance providers like Medicare and Medicaid. A healthcare business must receive proper funding to stay open and provide their patients with quality healthcare. Correctly billing patients ensures that healthcare providers and insurers get paid and that patients pay the correct amount for the services they require. Bulk billing refers to a situation where a health clinic bills Medicare or another insurance provider directly, so the patient isn’t charged after their appointment. If the clinic doesn’t bulk bill, the patient will be charged and request partial reimbursement afterward. The importance of accurate medical billing cannot be overestimated, especially as healthcare organizations are required to pay back any loss of money to their clients if a billing mistake is made. This costs healthcare businesses a massive amount of money, and Outsource Strategies found that errors on bills cost hospitals $68 billion annually.

Importance of medical billing

There are several reasons why medical billing is so important. Most fundamentally, medical billing is relied upon by healthcare providers so they can receive reimbursement from insurers. Although a medical appointment may seem like a simple two-way interaction, there is usually more at work. Medical billing involves medical codes explaining the procedures provided to the patient and information regarding the patient’s medical history and health insurance. The amount that the patient is required to pay will largely depend on what is covered by their health insurance. Accurate medical billing is critical for the health providers to be reimbursed, but also so that patients aren’t paying too much for the services they receive. The process can be complex, and many healthcare organizations employ third-party medical billing firms to ensure efficient and accurate reimbursement. Typically, medical billing involves three parties:

  • The patient
  • The healthcare provider (including hospitals, emergency rooms, clinics, therapists, physicians)
  • The insurance company

Understanding the main types of healthcare services billing methods

The billing method chosen by a healthcare practice will largely depend on their services and the type of clientele. We have provided brief explanations of some of the different forms of medical billing: 

  • Fee for Service: This billing method leads the practitioner to receive payment based on the services they provide. Patients’ services have specific codes that indicate what the healthcare provider should be reimbursed to insurance companies. The exact amount that a provider is reimbursed also depends on the type of health insurance that the patient has. 
  • Capitation: Capitation involves the healthcare provider receiving a determined amount of money to cover all services over a specific period of time to a particular number of people. This means that a physician will receive $X per patient every month regardless of whether the services that a patient requires cost $2,000 or $200. 
  • Bundled Payments (Episode-Based Payments): Bundled payments are a billing method where the healthcare provider receives a predetermined amount of money for a particular service. The decided amount is based on expected and average costs. For example, let’s say that the average cost of uncomplicated knee surgery is $15,000. This means that the provider will receive $15,000 for every knee surgery they perform regardless of whether a specific service costs more or less.

Healthcare organizations will select the medical billing that best suits their employees and the services they provide. Bulk billing medical centers will directly charge insurance providers, so the exact amount that a patient is required to pay will depend on the payment plans of their healthcare provider. These processes can be complicated and time-consuming, and many organizations utilize Private Practice software to maximize productivity.

Understanding the main types of healthcare services billing methods
Deep dive into bulk billing and its importance on your healthcare business

Deep dive into bulk billing and its importance on your healthcare business

Bulk billing plays a vital role in attracting potential patients to your practice. Bulk billing involves external insurance providers like Medicare and Medicaid. These companies are government bodies, meaning that they are funded by tax-payer money. Therefore, offering bulk billing to patients isn’t giving them free services as they have paid for healthcare with their taxes. Healthcare organizations often have specific services covered by bulk billing, including x-rays, general practitioner appointments, and pathology tests. In the case of unusual or complicated services, physicians can charge their patients an additional fee. Patients can reclaim this fee through their insurance provider following payment. 

On the other hand, bulk billing can seem disadvantageous for some doctors, and particular services won’t be bulk billed. If a healthcare company bulk bills a patient for a service, they accept the government's payment. Usually, the payment will be between 60-75% of the fee they charged the patient if they privately billed them. The healthcare practice will absorb the tremendous cost, meaning they deliver services not being paid for in full. Despite this payment gap, bulk billing often means healthcare businesses can offer quality care to patients who may not afford an appointment. Today, many healthcare organizations use mixed billing, where some of their services are bulk billed, and others aren’t. It is essential to understand that there is no correct way to manage your billing process, and a lot of your decisions will be based on the services you offer and how big your business is.

Bulk billing vs. private billing: Advantages vs. Disadvantages

As you can see, there are a variety of advantages and disadvantages for both bulk billing and private billing. Ultimately, the billing method that you choose will depend on your specific business services and needs. Healthcare organizations often use mixed billing, where particular services are covered by bulk billing, and others will require an upfront payment. 

Final thoughts 

The process of medical coding and billing is both critical and highly stressful. Health software has been developed to assist your medical billing by generating invoices, sending reminders, and facilitating online payments. Carepatron is a platform with a patient portal where clients can view appointment and payment information. Carepatron encourages timely payments with automated invoice reminders, allowing healthcare staff to spend less time on administrative tasks and more time seeing their patients! Ultimately, the medical billing method that you choose will depend on your business needs. Hopefully, this guide has indicated to you the many options you have to ensure your payment processes are seamless and efficient.   

Further Reading:

Bulk billing vs. private billing: Advantages vs. Disadvantages

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