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Medical Practice Use Of Automated Claims Options Growing Slowly

Posted on June 25, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study by a healthcare industry group has concluded that medical and dental practices are processing claims manually rather than going for full automation, a trend which is robbing the industry of very high levels of potential savings. While many physicians and dentists are using web portals to process claims, in most cases they haven’t reached the ”set it and forget it” level, a trend which could undercut possible savings.

The group, CAQH, tracks health plan and healthcare provider adoption of electronically-based administrative transactions for medical and dental practices. CAQH’s research estimates the time required for providers administrative transactions, including verifying a patient’s insurance coverage, sending and receiving payments, checking on the status of claims and handling prior authorization processes.

Its research concluded that despite the potential rewards, the medical and dental practices made only a modest level of progress in automating claims and related business processes over the past year. According to CAQH calculations, practices are still leaving roughly $11.1 billion in savings on the table, an estimate which has climbed by $1.8 billion over the prior year.

If these savings are realized, the majority ($9.5 billion) would end up in providers’ hands. However, many practices just haven’t gotten there yet.

A rise in portal use is certainly an improvement over paper-based claims processes. In fact, some of the increase in potential savings noted by the study is being created by a rise in online portal use.

However, providers’ adoption of fully-electronic claims is basically growing only a small amount or even declining for most transactions that can be done via a portal. For example, for prior authorizations, a big increase in portal use correlated with the decline in the adoption of fully-electronic transactions.

For CAQH, the endgame is getting all providers to automate claims processes complete, so the modest to flat growth in automated claims transactions is not exactly good news. In fact, it’s not a winning situation for medical practices either. According to the group’s estimates, each manual transaction costs practices $4.40 more than each electronic transaction and eats up five more minutes of provider time, which can create a real drag on profits.

Meanwhile, processing a single claim electronically through its lifecycle would save medical practices almost 40 minutes on average, and more than $15 in direct cost savings. Meanwhile, processing a single dental claim from start to finish could save dental practices almost 30 minutes on average and almost $11.75.

The CAQH press release doesn’t spell out what’s holding dentists and doctors back from automating the claims process completely, but it’s not hard to guess was going on. Unlike some providers, medical and dental practices typically don’t have deep pockets or large staff they can make this transition. If health plans want these providers to get on board, they’ll probably have to help them make the transition. However, even health plans haven’t invested in automated claims processing enough either.

Healthcare Revenue Cycle Mastery

Posted on November 6, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the trends I see happening today is many organizations focusing too narrowly on things like meaningful use that they don’t take time to handle many of the important financial aspects of a practice. Many people call this revenue cycle management, but I loved how this whitepaper called it Revenue Cycle Mastery.

The reality is that there’s so much more to revenue cycle than most people realize. Most people think revenue cycle is just about focusing on collecting payments quicker and getting more patients to pay their bills. While those are both important aspects of your revenue cycle, there’s much more to revenue cycle mastery. The above whitepaper breaks up revenue cycle mastery into these areas:

Chapter 1 Financial Clearance
Chapter 2 Check-in and Check-out
Chapter 3 Charge Capture
Chapter 4 Coding
Chapter 5 Charge Entry
Chapter 6 Claims Management
Chapter 7 Patient Statements
Chapter 8 Payment and Denial Posting
Chapter 9 Insurance Follow-up
Chapter 10 Denial Management
Chapter 11 Patient Collections
Chapter 12 Payor Management

I’m sure that every healthcare organization can look through this list and see ways that they can improve their organizations approach to revenue. If you’re not sure what each section means, download the full whitepaper where they go into detail on each.

While I’m excited about the benefits of IT on improving healthcare, I also think there’s a tremendous opportunity to use IT to improve revenue. Every chapter listed above could benefit from a well implemented IT system. IT might not always be the right answer, but it can usually help you accomplish some part of the equation faster.

Which of the topics listed above do you think is most important for a healthcare organization to solve first?