Consistent administrative rules slim down the need for paperwork
Now is the time for collaboration of payers, billers and providers to lead the industry by reducing inefficiencies
Key Points
NOW IS THE time for the collaboration of payers, billers and providers to lead the industry in healthcare reform by reducing costly administrative inefficiencies. Stakeholders have to trust each other and believe as a group they can effect change and accomplish goals.
A study by Thomson Reuters indicates the U.S. healthcare industry can eliminate $3.6 trillion in healthcare waste over the next 10 years by addressing known operational inefficiencies, such as complex and redundant transactions. Streamlining will go a long way toward slowing healthcare expense increases and curbing healthcare's share of the nation's gross domestic product.
COST-CUTTING INITIATIVES
Several initiatives are under way to reduce administrative costs. The Council for Affordable Quality Healthcare's Committee on Operating Rules for Information Exchange is bringing industry stakeholders together to achieve consensus on a set of operating rules for interoperability between providers and health plans. This will help reduce excess costs, multiple rules among payers and redundancy in the healthcare system.
The Patient Friendly Billing Project, a collaborative endeavor spearheaded by the Healthcare Financial Management Assn. promotes clear, concise, correct, patient-friendly financial communications. One of the latest reports from this decade-old project describes how high-performing hospitals successfully implement revenue cycle strategies by developing competencies in the key areas of people, processes, technology, metrics, communication and culture.
More recently, the AMA created a Health Insurer Code of Conduct, which challenges payers to commit to 10 principles. Two of the principles include administrative simplification and claims processing. The administrative simplification principle urges insurers to comply with laws governing use of electronic transactions and to disseminate clear, timely and accurate eligibility and benefit information, among other provisions. The claims processing principle calls for timely and accurate payment with clear and comprehensive information about how claims are handled and explanations of rationale when claims are denied.
In this episode of the "Meet the Board" podcast series, Briana Contreras, Managed Healthcare Executive editor, speaks with Ateev Mehrotra, a member of the MHE editorial advisory board and a professor of healthcare policy and medicine at Harvard Medical School. Mehtrotra is also a hospitalist at the Beth Israel Deaconess Medical Center in Boston. In the discussion, Contreras gets to know Mehrotra more on a personal level and picks his brain on some of his research interests including telehealth, alternative payment models and price transparency.
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Doing More and Saving More with Primary in Home Care
September 1st 2021In this week’s episode of Tuning In to the C-Suite podcast, MHE Associate Editor Briana Contreras interviewed VillageMD’s Senior Medical Director of Village Medical at Home, Dr. Tom Cornwell. Dr. Cornwell discussed the main benefits of primary care at home, which includes the benefit of cost savings for patients, maintaining control of hospital readmissions and others. Dr. Cornwell also noted what has changed in the industry of at-home care and if there has been interest from payers like insurance companies and medicare in the service.
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