In over 25 years of working in healthcare billing I have gained a wealth of billing knowledge and invaluable experience in areas such as coding, HFCA-1500, UB’s, electronic claims, audit trails, and insurance follow-up.
However, the experiences I’ve had with people, not processes, are what I hold most valuable. More specifically, I highly value the experience of adapting to change. People, processes and expectations change. Over time, I have witnessed a huge difference and incredible growth in how we must interact with people, from managing employees to how we interact with our consumers—the patients.
Not too many years ago, patients were mailed a “bill” for services rendered. There may, or may not, have been a description of who and how much were paid toward the charged amount. There was always an amount due and maybe, or maybe not, a small blurb about remitting payment. There was usually a statement like, “If you have any questions please call…” There may have been a handful of calls exchanged with the patient while they asked, “What was this for?” and “Did you bill my insurance?” and even “Why didn’t my insurance pay more?” During this period, it was simple to provide a quick answer based on the facts at hand, and recommend the patient contact their insurance carrier or pay their bill and submit for reimbursement if necessary. The cash generated from the patient payment portion was such a small percentage of the overall gross collections it easily becomes an afterthought to “assist” the patient in getting their bill paid. Man, how times have changed!
The patient of today is much more educated in what their insurance should pay and what type of treatment they should have received, as well as being in tune with each and every charge associated with their bill. Furthermore, they are aware that THEY are the CUSTOMER. Healthcare has gradually moved to more of a “the customer is always right” mentality. There is now a competition for patronage, and as a result, reimbursement is based on customer satisfaction by means of a grading system. Insurance companies have and are constantly changing their reimbursements based upon outcomes not merely tied to the success of procedures. Baby boomers are hitting their stride in the continual need for care. Therefore, coinsurance, co-pays, and deductibles are increasing.