balance billing

Balance Billing: What medical professionals need to know

Balance billing is a powerful way to bolster your patient collections process, but what is it & why should you be using it? We sat down with the Head of Client Experience at Healthbridge, Ivone Veiga-Moroldo, to talk about how balance billing can impact your practice’s bottom line. 


What is Balance Billing? 

Balance billing is the process of automating what portion of an invoice the medical aid will cover, & what portion the patient is liable for at the time of invoice creation. Currently, private practices that are not using balance billing will generate an invoice & send the claim to the medical aid. They then wait for a reply from the medical aid to know what to collect from the patient. In instances where practices are submitting claims in real-time – invoicing is a quick straightforward collections process & balance billing is usually not required. However, there are exceptions where balance billing is particularly important & useful. 


When is balance billing useful? 

If a private practice is not submitting claims in real-time, there is a delay between the consultation & billing the patient. This increases the risk of bad debt for the practice simply because they cannot collect from the patient at the time of service. This is especially important for specialists who charge above medical aid rates & who struggle to collect what is often the majority of the bill from the patient. 

Similarly, if a practice is claiming from a non-real time medical aid, there is also a delay between providing the service & billing. This increases your risk of not being paid in full & on time because the patient is again billed retrospectively, & in some instances, weeks (or longer) after their appointment.  

Balance billing minimises the risk of bad debt because medical aid & patient liables are pre-determined in your practice management system. When you generate an invoice, what the medical aid is expected to cover (based on their published tariffs) & what the patient will need to pay, is pre-calculated so that you can collect your patient co-payments immediately, before the patient leaves your practice & before you receive a response from the medical aid. 


Is balance billing the same as split billing? 

No, split billing is the process of generating two invoices – one invoice is sent to the medical aid for what they have agreed to cover, & a second invoice is generated for the patient with the remaining balance. 

Balance billing is characterised by a single invoice, with various line items & calculations so that the funder, the practice & the patient has a clear, unified picture of the total amount & liabilities allocated to each party. 


Does Healthbridge offer balanced billing functionality? 

Yes, balance billing functionality is built into our practice management application – myMPS. Healthbridge ensures that the system is updated with the latest tariffs from medical aids for consultations, medicines, & consumables. As a practice, you don’t have to find & input this data from every medical aid – it is done for you at no additional cost. This means you can generate invoices & collect co-pays from patients while they are still at your practice – a simple step that makes a huge difference to your risk of bad debt. It is another way we are helping doctors to get paid on time & run their best practice in challenging economic times. 

For more information about how you can use balance billing to support the patient collections process at your practice, click here.

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