大约十年前, 哈佛大学经济学家, 大卫·卡特勒, famously called out Duke University Hospital for employing 1,300 persons to administer billing for only 900 beds. 显然, that’s what it took in light of the many disparate requirements imposed by multiple payers (病人, 保险公司, the government) in every transaction. 近十年后, healthcare automation offers efficient alternatives in billing as well as many other business processes.
Automated claims processing
作为一个门槛问题, automating healthcare solutions requires effective health information management. Health information management holds significant promise with regard to eliminating delays and denials in the claims process, 这会影响纳税人, 供应商, 病人, and public health in general. Effective health information management not only directly addresses known issues in the claims workflow, but it is also a crucial first step in automating points along that workflow for optimal use of human capital, ROI优化, and enhancing employee- and patient/consumer-experience.
即:
- For every process a payer or provider automates, there’s less need for manual intervention.
- Automated processing enables full visibility 通过out the process.
- Intelligent data analytics tools help ensure efficient compliance efforts and enhance data privacy, routing related documents for the most efficient and appropriate reconciliation.
- Predictive analytics tools help 供应商 and payers plan for uncertainties, including appeals and resubmissions.
举个例子, Exela’s deployment of our custom, 自助服务, rule-based healthcare solutions saved a top 10 payer an impressive 35% in the cost of processing claims and amounted to a 50% reduction in cycle time and a 20% reduction in resubmission rates. 除了, increased transparency for payers, 供应商, and members vastly improved employee- and patient/member-experience and reduced the demand for customer-service interactions. You can learn more in this case study.
自动支付
自动计费 can be a game-changer by:
- Reducing the number of persons dedicated to the process, 减少花费的时间, and errors associated with, 手动控.
- Unifying payment data from multiple channels such as paper checks, 借方交易, 收集程序, 等.
- Enabling an improved patient communication strategy.
- Introducing other valuable efficiencies into the billing process such as HIPAA-compliant lockbox solutions.
事实上, we at Exela know how valuable such steps can be because we’ve seen it first-hand in solutions we’ve provided to our customers. 例如, in the case of a major academic health system whose outdated payment operations had been mired in manual, error- and loss-prone processes, we deployed our Patient Financial Services suite to streamline information ingestion, facilitate communications, 优化工作流程, with the result being a 25% reduction in full-time employees needed for these operations and a 30% increase in collector efficiency. You can read more about it in this case study.
除了 to streamlining claims by avoiding denial of payment 通过 improved coding, delivery of clean claims, and facilitating all related inter-stakeholder communications, 自动化可以 optimize revenue integrity 通过, 除此之外, data mining for the purpose of predictive analytics and revenue forecasting, all in the service of identifying and recovering all amounts in the most effective and efficient manner. 例如, when a large healthcare system wanted a way to maximize reimbursement under their many payer contracts (all of which had different requirements, 条款, 和条件), Exela deployment of its healthcare automation solutions resulted in 99.6% accurate reimbursement and identified 98.4% of underpayments and calculated predicted reimbursement under all payer contracts. “We look forward to continuing our relationship with Exela for years to come,” commented the customer in this case. “应急, success fee based engagement has provided an extremely positive, financial bottom line return, while requiring minimal staff time on our part...”
此外，我们的 medical lockbox solutions support 供应商 in managing (and reducing the costs associated with managing) a high volume of receivables payments. 和 our newly-launched Real Time Payments solution can streamline the collection of remainders from 病人 using secure messaging and convenient payment options (via text message with payment options).
Automating accounts payable
It’s not just the core businesses of stakeholders that benefit from automation. 例如, another of Exela’s customers, a national urgent care provider, had been processing more than 50,000 vendor invoices per month, resulting in lost documents and delayed payments to vendors, before turning to Exela to fully automate its burdensome paper-based workflow. 除了 to streamlining payment to vendors and lowering the incidence of defaults and discrepancies, the user-friendly interface equipped the provider with the tools needed to readily address discrepancies if they arose and permitted the provider’s vendors to check invoice status online.
In the case of a major pharmaceutical company with a global footprint and driven by constant research and development, Exela was able to harmonize, 数字化, and automate the more than 50,000 incoming invoices from 40 different business areas in 19 different countries 通过 a custom-tailored combination of digitization services, 数据提取, 报告, 和汇款.
自动化招生
Open enrollment is a payer-specific issue, and it’s always challenging. With ever increasing pressure to outperform the previous year’s results, there’s always a need for process innovation to meet increasing demands. Pressures are compounded by a short enrollment timeframe and employees who find the process confusing. The result is numerous queries and insufficient enrollment documentation. A large insurance company customer of Exela had been struggling with this scenario to the point that its satisfaction scores with 供应商 and members were being severely impacted. Exela designed a universal intake and workflow solution to manage all the various modes of communication between the payer and the employees/potential members. In less than 90 days, Exela delivered 240,000 enrollment installations a month at a quality of 99.5% with significant cost savings in the form of reduced call volume and reduced pending items. Customer satisfaction soared.
对患者的好处
The administrative complexity of the U.S. system also burdens 病人, whether they are deciphering bewildering bills or shuttling records between 供应商. Three-quarters of consumers report being confused by medical bills and explanations of benefits. A Kaiser Family Foundation survey of people newly enrolled in the health insurance marketplace found that many were not confident in their understanding of the definitions of basic 条款 and concepts such as “premium,”“免赔额,” or “provider network.” Insurers and employers spend an estimated $4.8 billion annually to assist consumers with low health insurance literacy, according to McKinsey.
For the full story on how technology can solve costly inefficiencies in the health industry, be sure to check out our Q4 Edition of PluggedIN: Tell Us Where It Hurts: How Tech Can Heal Healthcare.
来源:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511963/
http://www.streamlinehealth.net/HIM-blog/revenue-integrity-can-organization-best-achieve/ http://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/promoting-an-overdue-digital-transformation-in-healthcare
