In healthcare, automating every step of the pre-adjudication cycle – meaning anything that happens before the payment of a claim – allows claims to be processed more efficiently and more accurately. As claims processing improves, auto-adjudication rates rise and the total cost per claim falls.
Healthcare payers and benefit administrators are provided with pre-adjudication technologies that replace error-prone human processes and provides applications for PPO network management, document management, workflow and overpayment protection. These solutions improve adjudication rates, increase payment accuracy and enhance customer service. Simply put, business process outsourcing can provide better, faster and more cost-effective processing than any manual, in-house paper-based method.
The review, investigation and processing of claims can be time-consuming and prone to human error. By initiating an advanced healthcare claims processing system, you can alleviate many of these issues and ensure the accuracy of all claims processed.
Paper and electronic data interchange (EDI) claims can be imaged and converted to electronic format and transmitted back to integrate with the appropriate claim system. With a special focus on the front-end operations for claims processing, 100 percent electronic claims submission can be enabled to reduce administrative costs and improve auto-adjudication rates.
The most trusted BPO providers have made significant investments in enterprise software and infrastructure development, specifically addressing data security requirements. Annual external audits can ensure compliance; and multisite processing models can allow for superior business continuity and disaster recovery capabilities.
For years, Electronic Data Interchange (EDI) claims submission has reduced payer rejections and administrative costs while increasing the speed of the payment. So why do EDI transactions still have adjudication issues? The reason is that the best data the provider has is simply not good enough.
Payers and providers have natural differences in update cycles, systems and business processes that contribute to adjudication errors. Payers contract with providers at longer periods than members – and members often update their information only annually.
More often than not, data is never given to the provider until an encounter, so demographic data becomes stale very quickly. This means providers have little opportunity to get patient data corrected. Plus, they have limited resources and capabilities to keep their own demographic data synchronized with every payer.
Healthcare claims processing can involve expensive and serious consequences if the data is not processed correctly. To address these issues, healthcare payers and benefit administrators are turning to digital pre-adjudication technologies to replace error-prone human processes and increase claim payment accuracy. This involves electronically organizing the data before the payment of a claim is made.
Using technology instead of manual processes allows the solution to be customized to adapt to specific business requirements and improve performance without additional capital investment. Advanced BPO providers can automate the claims process, including claim data cleaning to increase claims quality and reduce overall costs.
With the right technology, healthcare claims can be improved so that they match system files; thus, lowering reject rates and improving adjudication rates all while ensuring HIPAA security and consistency.
Automation Technology Can Advance the Claims Process
The latest automation technology can increase data accuracy, lower costs and bring faster cycle times to the healthcare claims process. The technology can automate and integrate all aspects of pre-adjudication claims processing, including cleaning and enhancing claim data.
BancTec representatives this week presented a smarter way to outsource healthcare back-office processes at the HIMSS13 Annual Conference & Exhibition in New Orleans.
Using its Intelligent BPO (iBPO) methodology, BancTec delivers advanced healthcare BPO solutions designed specifically to improve process efficiency and reduce costs.
Intelligent healthcare solutions improve provider/patient relationships by helping improve collections, eliminate write-offs, increase yields, and enhance in-process claim visibility. For healthcare providers, BancTec offers medical lockbox services, EOB processing and medical records management. Additional services include claims processing, AP automation and inbound mail services.
“At BancTec, we listen to the concerns of healthcare providers and payers so we can deliver a smarter, customized outsourcing solution,” said Chuck Corbin, vice president for strategy and business development at BancTec.
BancTec discussed a number of healthcare concerns at HIMSS13. In the video below, Corbin examines one pain point for healthcare providers and how medical lockbox services can help.
Protecting patient records, locating information faster, and reducing administrative overheard are just a few challenges faced by healthcare providers today. Whether you are a hospital, clinic or small practice, you should evaluate your Electronic Healthcare Record (EHR) strategies.
Because manual medical records processing is cumbersome and time-consuming, today’s healthcare companies utilize various outsourcing solutions. Proactive organizations are using business process outsourcing in their medical records operations to simplify processes and improve efficiencies.
One concern many companies have about outsourcing solutions is security. Outsourced solutions can have robust security features that safeguard your documents and their integrity. But your potential BPO vendor must understand healthcare and the need to comply with regulations.
Outsourcing solutions can help healthcare organizations accelerate billing and collections, simplify HIPAA compliance and improve accountability. The costs of meeting HIPAA regulations can be reduced with digital records storage and comprehensive security measures.
Reap the Benefits of Electronic Medical Records
The federal government has mandated a shift towards electronic medical records, and BPO providers can help physicians and hospitals adopt a better system, avoid penalties, and receive implementation payment incentives.
The security of medical records and healthcare claims is a sensitive issue recognized by industry leaders in healthcare. HIPAA compliance standards ensure that healthcare claims and related information remain secure and protected.
The most effective claims processing is accomplished with automation technology that offers advanced pre-adjudication services. These services take care of everything that happens before the payment of a claim. However, some claims still require exception processing – meaning human intervention to investigate and correct individual fields that don’t meet standards.
The option of hybrid onshore/offshore claims processing has become a model worth considering. Redaction is made possible using form definition technology to slice through each claim image, and physically separates the patient/insured section, which contains the personally identifiable information (PII), from the rest of the claim. Redaction technology eliminates any possibility of a person or software illicitly obtaining the image or OCR results for PII fields.
With this model, the fragment containing PII can be routed to a trusted onshore location for exception processing while the non-PII fragment containing provider and service lines can be routed to an offshore location for exception processing at a lower cost. This balance creates a cost-effective process that meets all state-mandated requirements.
Leaders in healthcare have long recognized the challenges when it comes to claims processing. Healthcare payers and benefit administrators have begun to focus on the front-end process to help reduce operational costs, increase adjudication and first-pass rates, and improve overall customer service.
Inaccurate, incomplete or erroneous data – dirty data – often results from a lack of updating of claim filing with payer system records. This data must constantly be synced to allow for increased member and provider matching.
Furthermore, as a result of healthcare reform, federal agencies are initiating more robust audits, leveraging new technologies and focusing on improved healthcare processing integrity. These efforts reduce payment errors and prevent taxpayer dollars from being wasted in payments to the wrong people and in the wrong amounts.
Electronic claims are becoming an industry standard, and patient privacy is one of the most important elements of healthcare information technology. With HIPAA requiring facilities to protect their electronic medical records with the proper IT security controls, guaranteed compliance with stringent security and information safeguards is essential.
BancTec’s Chuck Corbin discusses the complex tasks healthcare providers and payers face when it comes to claims processing, including reconciliation of claims, incoming EOBs and payments, compliance mandates and more. He explains why the opportunity lies in the management of financial transactions in the healthcare sector in the United States.
Today’s post is from Coley Clark, BancTec’s chairman of the board and chief executive officer.
As we near the end of an eventful year, I’d like to wish the happiest of holidays to BancTec’s customers, partners and employees. This year marked our 40th anniversary, a real milestone for BancTec and a reminder of the rich heritage we enjoy.
BancTec continues to establish itself as a leading BPO provider across many industry sectors. In particular, we have made significant advancements in the healthcare industry, accelerated by the acquisition of GTESS and its healthcare claims processing services. In Europe, we continue to leverage our financial services experience. BancTec has captured 100 percent of the outsourced GIRO payments in Sweden.
Looking to the future, we know that the new year will bring new challenges and opportunities. I am confident that together we will embrace the challenges and take full advantage of the opportunities.
Until then I wish you safe and happy holidays with family and friends, and a joyous, prosperous new year.
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