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Patient Portals, EHRs, and Third Party Billing


Patient portals provide cost effective tools to interact with patients on a wide range of administrative, billing, and scheduling issues at lower costs for your organization. They offer an added value benefit to your clients.

Patient portals facilitate the exchange of information on billing and administrative issues. They can help practices acquire updated patient demographic information and new insurance information as well as coordinate appointment scheduling and process payments. For example, patients can review the status of their claims and their current statement through a patient portal.

Patient portals also play an important role for electronic health records. Clinical patient portal features include: requesting refills, exchanging messages, reminding patients about treatment plan items, and accessing patient exam notes. Patient portals can collect patient family / social history and even history of present illness as well as monitor patient wellness on a periodic basis. Clinical information may be accepted directly into the EHR's patient note for editing by the doctor or staff. Thereby, practices save time documenting patient conditions and history. The patient exam notes may be accessed and take the place of a patient call to review their previous visit or current treatment plan items.

For the third party biller, patient portals present a valuable service opportunity for clients and their patients. However, they also represent a logistic challenge since the patient portal strategy must support the EHR as well as the practice management system (PMS).

From a product development standpoint, patient portals have paralleled the EHR industry. Originally, most were developed as stand-alone products that were painstakingly interfaced with EHR and medical billing systems. Many EHR and medical billing vendors have established joint marketing programs with patient portal vendors or purchased patient portal products. In other words, a practice's ability to work with a number of patient portal options is rapidly diminishing.

The business landscape for patient portals has been dramatically affected by Meaningful Use and the evolution of the EHR industry. Patient portal clinical features support Meaningful Use measures such as delivering clinical summaries, providing patient education, and issuing patient reminders. Under Stage 2 of Meaningful Use, practices will have to support the exchange of messages, mostly through a patient portal tool. As a practical matter, key patient portal functionality is being driven by the EHR related features.

The partnering of patient portal vendors and development of proprietary patient portal offerings presents two significant dilemmas for the third party biller:

Practice Management System Interfaces — In addition to interfacing the billing system with the EHR, the billing system also must interface with the patient portal. Assuming that the billing system sends demographic and appointment information to the EHR and receives charge information from the EHR, the patient portal will have to direct certain transactions to the billing software and other transactions to the EHR. For example:

  • Interactions on demographics and appointments would be sent to the billing system, and the billing system would send update transactions to the EHR.
  • Many patient portal interactions must be vetted by the billing or clinical staff before updating the billing system. For example, patient portal sourced appointment requests would be approved before the patient could be posted to the actual schedule. Nonetheless, the EHR will have to be updated in a timeframe that accommodates the patient's continuing interactions with the patient portal and practice on clinical as well as billing issues.
  • Clinical messages would be managed through the interface with the EHR. In some cases, these patient portal exchanges work directly with the EHR, while other strategies rely on maintaining a copy of the information from the source billing and EHR products.

Full Product Suite Offerings — Many vendors are moving to a full product suite that includes medical billing / PMS, EHR, and patient portal modules. The competitive landscape is dramatically evolving and your clients may be considering choices where the primary consideration is the capability of the EHR and patient portal combination with limited consideration of interfaces with practice management system options. In order to support your clients, you may need a billing system strategy that aligns with their EHR and patient portal needs.

Patient portals offer a number of opportunities to interact with patients on medical billing and patient service issues in a cost effective and patient service-focused manner. However, the use of patient portals requires careful planning to assure that you can adequately and effectively support clients as they improve patient services through the technology of a patient portal.

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