Tyler Shepherd Contributor
Medical billing is a critical part of the U.S. healthcare system, which continues to experience consistent growth. Healthcare spending in the U.S. rose 7.5% to $4.8 trillion in 2023. In a multi-payer system such as the U.S., healthcare providers may be paid by multiple entities, including the government (Medicare and Medicaid), private insurance companies, and patients themselves. Unfortunately, due to the sheer number of parties involved, and amid a landscape of constantly changing payment rules and worsening medical inflation, obtaining payment for services rendered can be complicated and burdensome, putting healthcare providers and facilities at risk financially.
Michael N. Brown, founder and CEO of Fellow Health Partners (FHP), a leading medical business solutions company, has created a new and innovative approach to medical billing in response to the fragmented revenue cycle in healthcare. Brown explains that, due to the complexity of billing, many medical providers are unable to perform this function in-house, and may end up walking away from up to 12% of their revenue due to not having the expertise or resources to go after it. He adds that a doctor may perform the exact same procedure five times yet get paid different amounts for four of those procedures, and not get paid at all for the fifth. This is because many healthcare entities do not have the technology or means to comprehensively identify and resolve underpayments and/or denied claims.
As an alternative, medical providers may opt to engage with external billers, in the hopes of capturing at least some of the revenue they would otherwise be missing out on. However, Brown observes that most billing solutions fall closer to two ends of a spectrum. On one end are the ‘mom and pop’ billers who may be diligent and trustworthy but lack the technological resources to grow and scale with their clients, and may not have the ability to adapt to rapidly changing government regulations and payer policies. On the other end are large “assembly line” billing companies that rely on quantity over quality, focused on filing a high volume of claims rather than being thorough with each claim, adversely affecting reimbursement.
According to Brown, for a medical billing company to succeed in today’s complex and fragmented healthcare infrastructure, a new approach is required. He established FHP to improve revenue and customer service in hospital networks, ambulatory surgical centers (ASCs), and physician groups. Instead of trying to fix what Brown believes is a broken system, FHP seeks to build a new one. This is accomplished by focusing on three key aspects: Technology, Talent, and Training.
As part of its mission to build a new billing framework, FHP first developed and implemented workflows designed to boost its human capital. Following this, FHP turned its focus to automation, implementing robotic process automation (RPA) technologies to automate as many tasks as possible.
Brown says that many large billing companies end up leaving money on the table because they have not automated to the degree necessary to resolve underpayments and denials. Without automation, a biller just can’t collect every dollar due for its clients.
One of FHP’s flagship technological innovations is SAVi™, a proprietary platform that streamlines workflow, improves client access to data, and optimizes business processes. It integrates easily with virtually all electronic health record (EHR) systems while providing clients with real-time, 24/7 access to all their data. FHP customizes SAVi™ for each client, allowing it to generate the most relevant reporting and analytics, and help clients earn more money while reducing their administrative headaches. Meanwhile, providers that are shifting to FHP’s platform can benefit from SimpleSwitch™, which allows them to maintain their income and avoid cash flow interruptions.
Through FHP’s emphasis on optimization, efficiency, performance, and productivity, it was able to achieve a 20% reduction in cost to collect, and a 35% increase in net patient revenue for its clients. Automation also allowed FHP to maintain its cost profile with clients in a rapid inflationary environment, while delivering these exceptional results.
Brown believes the technology FHP developed is crucial in building trust with clients as it delivers better results than old frameworks that relied mostly on human capital. In the medical billing industry, getting ‘better results’ is defined as being able to collect more money on behalf of the client, while keeping costs low.
He adds that an important part of building and maintaining trust with clients is providing assurance that clients’ data is secure and complying with relevant privacy regulations. FHP regularly undergoes system security audits to ensure that its systems and data are protected against unauthorized access. These System and Organization Controls (SOC 2), result in a comprehensive CPA’s report attesting to the effective management of security, processing integrity, privacy, confidentiality, and availability within FHP systems. The SOC 2 report, tailored to meet the assurance needs of current and potential customers, highlights FHP’s commitment to maintaining robust controls for processing customer information. This is especially important due to the rising frequency and severity of cyberattacks on healthcare systems around the world, with millions of patients’ data being compromised.
Aside from technology, FHP builds trust with clients by ensuring that its talent and training are top-notch. It established Knowledge College™, a training and testing center for medical billing and coding, certified by the American Academy of Professional Coders (AAPC), to help its team members sharpen their skills in medical billing and coding. FHP is also continually expanding its service offerings, including advisory services, to help clients grow their businesses.
However, Brown notes that technology is not a replacement for communication. Rather, FHP uses technology to more efficiently handle the workload and lower costs, allowing its staff to communicate properly with clients and provide the human touch that is valuable in growing trust. Clients want to be able to pick up the phone and talk to someone directly who is knowledgeable about their particular practice. FHP regularly communicates with its clients, providing timely updates on billing progress, industry trends, changes to payer policies, and any other factors that may affect their revenue. Constant and consistent communication aligns expectations, prevents misunderstandings, and creates partnerships between FHP and the clients they serve, all resulting in a greater level of trust.
“As healthcare costs continue to explode, it is becoming increasingly important for healthcare providers to collect every dollar due to remain sustainable,” Brown says. “Since FHP was founded in 2017, we have built a huge degree of trust with our clients, employees, and the rest of the industry via creating and implementing new technologies, being a leader in medical billing and coding education, and ensuring data security and regulatory compliance. We look forward to building stronger relationships with all stakeholders and continue our mission of providing unparalleled revenue cycle solutions through our customer-first approach that provides clients with the experience they need and the personal touch they deserve.”
