Claims processing can be a very time-consuming and complicated job. As recovery audit contractors scrutinize claims more closely, it is essential to have accurate documents. Sal Novin, CEO of Healthcare Productivity Automation, and Igor Kikena, director of Technology and Implementation at HPA, describe how business process automation can help hospitals make claims processing quicker and more accurate.
True automation
Mr. Novin and Mr. Kikena explain that the term "automation" has become a buzz word in healthcare, and that its true capabilities are underestimated because people use the term as a catch-all for a variety of processes. They say automation is a useful strategy for creating efficiencies and not merely a simplistic tool such as data transfer. When hospitals invest in true automation software, they can reduce labor costs, speed workflow processes and increase quality.
Efficiency
One of the ways automation creates efficiencies is by being scalable; it can scale more quickly and easily than manual processes could. Cloud-based automation services are especially scalable. "When you have a service that's cloud-based, you have a tremendous amount of scalability inherently built in," Mr. Novin says.
Another benefit of cloud-based systems or software-as-a-service (SaaS) is hospital staff need significantly less training and support to use them because the system is hosted and managed off-site by the vendor. Mr. Novin estimates SaaS solutions may reduce workloads in training, support, maintenance and implementation of automation solutions by 50-70 percent. These reductions can dramatically reduce the rate at which a hospital responds to commercial- and compliance-based changes, such as ICD-10.
Quality
Automation can significantly improve the quality of medical claims processing because it decreases processing variance. Manual claims processing can have as much as 30 percent variance, while automated processing produces less than 1 percent variance, according to Mr. Novin. Automation can also more easily manage complex claims, easing the burden on staff. Ensuring the quality of the process is critical, as a large percent of variance between claims might trigger audits by recovery audit contractors.
An example of how automation can capture more claims than manual processing is the cyclical volume changes at hospitals, Mr. Kikena says. During flu season, for instance, the majority of claims are for the flu. As volume from flu patients grows, hospital staff is stretched thinner, making it easier for more complex claims, which may receive higher reimbursement, to fall through the cracks, Mr. Novin says. "The risk is that [hospitals] may miss high dollar claims or make mistakes on them as a result of these less expensive, but high volume issues that occur seasonally," he says.
Another key advantage of using automation for claims processing is it provides metadata — "data about your data," Mr. Novin says. Hospitals can analyze the data to identify opportunities for improvement. "Automation provides the perfect tracking mechanism to trend data," Mr. Kikena says.
Learn more about Healthcare Productivity Automation.
Related Articles on Revenue Cycle:
CMS Issues Physician Fee Schedule Proposed Rule
HHS Issues Electronic Standards for Healthcare Transactions
How to Optimize Your Hospital's Revenue Cycle to Achieve Efficiencies, Savings
True automation
Mr. Novin and Mr. Kikena explain that the term "automation" has become a buzz word in healthcare, and that its true capabilities are underestimated because people use the term as a catch-all for a variety of processes. They say automation is a useful strategy for creating efficiencies and not merely a simplistic tool such as data transfer. When hospitals invest in true automation software, they can reduce labor costs, speed workflow processes and increase quality.
Efficiency
One of the ways automation creates efficiencies is by being scalable; it can scale more quickly and easily than manual processes could. Cloud-based automation services are especially scalable. "When you have a service that's cloud-based, you have a tremendous amount of scalability inherently built in," Mr. Novin says.
Another benefit of cloud-based systems or software-as-a-service (SaaS) is hospital staff need significantly less training and support to use them because the system is hosted and managed off-site by the vendor. Mr. Novin estimates SaaS solutions may reduce workloads in training, support, maintenance and implementation of automation solutions by 50-70 percent. These reductions can dramatically reduce the rate at which a hospital responds to commercial- and compliance-based changes, such as ICD-10.
Quality
Automation can significantly improve the quality of medical claims processing because it decreases processing variance. Manual claims processing can have as much as 30 percent variance, while automated processing produces less than 1 percent variance, according to Mr. Novin. Automation can also more easily manage complex claims, easing the burden on staff. Ensuring the quality of the process is critical, as a large percent of variance between claims might trigger audits by recovery audit contractors.
An example of how automation can capture more claims than manual processing is the cyclical volume changes at hospitals, Mr. Kikena says. During flu season, for instance, the majority of claims are for the flu. As volume from flu patients grows, hospital staff is stretched thinner, making it easier for more complex claims, which may receive higher reimbursement, to fall through the cracks, Mr. Novin says. "The risk is that [hospitals] may miss high dollar claims or make mistakes on them as a result of these less expensive, but high volume issues that occur seasonally," he says.
Another key advantage of using automation for claims processing is it provides metadata — "data about your data," Mr. Novin says. Hospitals can analyze the data to identify opportunities for improvement. "Automation provides the perfect tracking mechanism to trend data," Mr. Kikena says.
Learn more about Healthcare Productivity Automation.
Related Articles on Revenue Cycle:
CMS Issues Physician Fee Schedule Proposed Rule
HHS Issues Electronic Standards for Healthcare Transactions
How to Optimize Your Hospital's Revenue Cycle to Achieve Efficiencies, Savings