Hospital Billing
The Hospital Billing module provides comprehensive revenue cycle management specifically designed for inpatient care. This module handles the complex billing requirements of hospital stays, including insurance verification, charge capture, claims management, and patient billing.
Key Features
Patient Financial Services
- Insurance verification and eligibility
- Prior authorization management
- Benefit estimation
- Financial counseling documentation
Charge Capture
- Automated charge triggers
- Charge reconciliation
- Ancillary service billing
- Supply and implant charges
Claims Management
- DRG assignment and optimization
- Coding compliance checks
- Electronic claim submission
- Denial management workflow
Patient Billing
- Statement generation
- Payment plan management
- Online payment portal
- Collection workflow
Billing Models
DRG/Case Rates
- MS-DRG and APR-DRG support
- Grouper integration
- Documentation improvement
- LOS management
Per Diem
- Daily rate configuration
- Level of care adjustments
- Add-on service billing
- Length of stay tracking
Fee-for-Service
- Charge master management
- Detailed service billing
- Procedure and supply charges
- Time-based service tracking
Financial Analytics
Revenue Performance
- Service line profitability
- Payer mix analysis
- Reimbursement trends
- Charge capture leakage
Operational Metrics
- DNFB (Discharged Not Final Billed)
- A/R days by payer
- Clean claim rate
- Denial root cause analysis
Integration Points
The Hospital Billing module integrates with key hospital systems:
- ADT: Admission and discharge triggers for billing cycles
- Clinical Documentation: Diagnosis and procedure coding support
- Pharmacy: Medication charging and reconciliation
- Materials Management: Supply and implant charging
- Contract Management: Payer terms and rate calculation
Implementation Considerations
- Develop comprehensive charge capture workflows for each department
- Configure payer-specific rules and requirements
- Establish coding validation and documentation improvement processes
- Create charge reconciliation protocols to prevent revenue leakage
- Ensure compliance with regulatory billing requirements
Compliance Features
- Coding Validation: Automated checks for coding accuracy and completeness
- Medical Necessity: Validation against payer requirements
- Charge Audit: Reconciliation between services provided and billed
- Documentation Support: Tools to ensure billable services are properly documented
- Regulatory Updates: Regular updates to maintain compliance with changing regulations