4. Increased automation
Streamlining claims and administrative processes would be a game changer to the industry. Billing and insurance-related administrative expenses cost more than $375 billion, accounting for about 15% of total healthcare costs in the United States, according to a 2015 report by BMC Health Services Research. A simplified billing system would not only save money, but it would push the industry toward being more in step with other automated consumer experiences.
Craig Kasten, cofounder of Skygen USA, says in the next decade, healthcare organizations that aren’t able to process claims and authorizations in the same day will be obsolete.
“During the next five to ten years, healthcare payers will either adopt new technologies and automated processes, or they will be replaced by competitors with lower costs that offer
innovative services and deliver a much better experience for both providers and patients,” Kasten says.
Reliance on paper and outdated technology can be tedious, slow, and increase vulnerabilities to data breeches, Kasten says.
“Health plans need technology solutions built with electronic communications and process automation as the foundation of the architectural design, rather than technology centered on paper forms and manual processes, Kasten says, adding that newer systems need to have the capability to adapt to evolving technologies. “Many hospitals and health systems in particular are making investments in revenue cycle management technology in an effort to create greater efficiencies, reduce waste, and improve the member/provider experience. Incorporating automated claims submission, remittance advice, payments, etc., into those technologies will greatly increase the value of those investments and help them manage their cash flow more effectively–an important consideration given the challenges that come with the transition to value-based care coupled with ever-shrinking margins.”
Kasten says that real-time automated determinations and claims adjudication will result in more accurate and reliable claims payment, lower accounts receivable balances,more consistent revenue streams with faster and easier daily reconciliation, and reduced reliance on collection agencies to pursue unpaid patient bills and unpaid claims from insurers.
Health plans will benefit from significantly fewer calls from providers seeking claims status and payment information, fewer duplicate claims submissions, fewer denied and resubmitted claims, higher provider satisfaction, a better experience for patients, and higher productivity and lower administrative costs as same-day accounting and reimbursement encourages providers to abandon paper and engage in electronic relationships.
“To achieve the best outcomes with the lowest costs, health plans must invest in modern technologies that seamlessly automate routine administrative functions, while streamlining processes that do require human judgement, such as instantly providing a full, online view into patient treatment history, allowing clinicians to make medical necessity determinations efficiently and accurately,” Kasten says.