What you need to know about patient portal billing

With more patients bearing the cost of medical bills than ever before, payment collection strategies are becoming increasingly important for provider solvency.

Patient portal options for billing are but one part of an overall engagement strategy that providers are turning to as patients seek the kinds of consumer retail experiences offered by Apple and Amazon.

Payment design and current-state billing are critical drivers.
The rise of high-deductible health plans is a critical factor in patient billing. As patients take on ever-increasing cost shares, providers have had to improve their systems for billing and collecting at the individual rather than the group payer level. In fact, Healthcare Finance reports a nearly 30 percent rise in patient cost share from deductibles and out-of-pocket expenses since 2015.

Adding to this challenge is the paper maze attached to the service-to-benefit-to-bill experience. It can be challenging for even the most informed consumer to match up an explanation of benefits (EOB) to the bills they received. Contributing to this is bill lag. Statements may arrive six months or longer after care was delivered and represent a combination of facility and provider charges, some of which may not fall in-network. This frequently occurs for those seeking emergency care.

Your billing portal should be part of a larger patient engagement strategy.
Today’s billing strategies are increasingly shifting to the needs of the payer, not the biller. A 2017 Black Book Revenue Cycle Management Survey cites these statistics:

  • Online bill pay comprises more than 60 percent of patient payments.
  • More than 70 percent of patients link provider satisfaction with mobile pay and billing alert options, yet only 20 percent of providers are currently offer these capabilities.
  • Offering pre-service cost estimation, increasing cost transparency, and delivering payment convenience are valued as highly valued by providers as they are patients.

This last statistic is key, citing how patient and provider needs around billing are converging with both populations desiring the earliest possible engagement around discussions of cost.

Patient engagement is linked to conversion, and portals that are user friendly are more likely to convert a patient from paper billing and increase pay percentages, pure and simple. Simplee touted itself as one of the first companies to design payment solutions from the patient perspective, dubbing their solutions “revenue cycle designed for patients” as part of their “digital ecosystem for patient financial care” strategy. Simplee plots pre-service estimates as part of its patient engagement map and integrates PayPal as method of payment.

Consider billing portal capabilities when choosing an EHR vendor.
EHR rollouts are notoriously complex, expensive and lengthy. Multi-phase rollouts are common and advised, even for the most innovative providers, and are often grouped by provider type (e.g., captive versus independent physicians first). Health systems should make billing portal capabilities an early part of their EHR vendor scope discussions, even if implementation comes many phases later. Mayo has moved to a one-bill model as part of its continued Epic EHR rollout that gives patients a streamlined view of services provided across their locations. Conversely, smaller and/or independent physician practices may prefer to consider their billing systems separately.

Think mobile.
While patient portals remain a huge step forward for some providers, many are already offering mobile billing options. Epic’s popular MyChart app offers bill pay as part of an overall engagement experience that lets patients view health information, manage appointments, and communicate with providers. As of 2017, MyChart lets patients to share their data with providers via Share Everywhere, which also allows providers to update the information they receive with progress notes.

Different ways to pay
Whether patients access bill payment via PC or Smartphone, offering different ways to pay is another critical feature of patient engagement. Today’s systems offer more than credit card options. Instamed made headlines nearly three years ago as the first healthcare company to offer patients Apple Pay to settle their bills. And while similar big announcements have not followed for other mechanisms, such as Android Pay and Google Wallet, it’s likely only a matter of time.

Even cryptocurrency and blockchain are making appearances in the patient billing discussion. Becker’s recently featured three providers - two in California, one in New York - that accept Bitcoin payment. And while uptake is small, this option reflects just how far patient payments have come.

Security is critical.
Security with both platform and mobile bill pay is critical. Even health systems that offer billing apps have not yet made Apple or Android one of their payment options, citing security reasons. Patient portals that integrate a payment solution can be the most secure. Compliance with Payment Card Industry Data Security Standards (PCI DSS) is key, whether payment is processed via traditional card or digital wallet. For the latter, the use of tokens improves security and reduces the risks associated with stored payment information. Solutions like Apple Pay leverage a trifecta solution, using Near Field Communication, a secure element (chip-specific and token security), and touch ID for authentication.

Don’t eliminate your other collection mechanisms just yet.
While patient billing portals are no doubt where the industry is going, it’s critical to keep your other collection mechanisms in place. If your online portal isn’t set up to deliver text and/or email reminders, the paper bill is still your most effective way to keep past-due balances top of mind with patients. Using the credit card on file (CCOF), particularly for lower balances, is still an effective way for patients and providers to get caught up.

Much is written about the patient experience. Is your patient likely to ditch your practice because of your billing system? No. The lower premiums offered by narrow networks and high-deductible health plans still protect against that. But there’s no doubt that the patient billing and payment revolution is under way.

Laura Beerman is a writer for TechnologyAdvice. Her insights have appeared in RevCycleIntelligence, Becker’s, InformationWeek and other outlets. She has spoken nationally on population health, long-term care, and been interviewed by The Wall Street Journal for her accountable care predictions. She resides in Nashville with her Canadian husband and American kittens. You can find her on LinkedIn.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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