Outsourcing can solve medical claims issues

Outsourcing can solve medical claims issues
The U.S. health care industry’s claims payment system is frustrating for a great many providers, payers and patients. Thanks to inefficiencies  and widespread tendencies toward error, resources are wasted, communication becomes worse and mistrust grows among all stakeholders, all of which inhibits the industry’s ability to transition to value-based models.


What’s more, despite the investment of billions in an attempt to achieve efficient claims payments, more than seven present of claims not paid correctly the first time, the second time and – sometimes – not even the third time. In response, an entire sector of the industry has evolved to examine claims retrospectively, identifying incorrect payment and then attempt to reconcile them.


In addition to wasting time and money, this concept impedes providers’ ability to manage their revenue cycle effectively, eroding their confidence in payers. Consumers, like providers, expect those claims to be paid quickly and accurately, but in a system focused more on correcting payments rather than getting them right the first time, that’s often not the case.


Though automating the process could be a potential solution, right now it might be adding to the problem. Many organizations use a combination of automated and manual processes, which result in gaps allowing inaccurate payments and errors, then additional automation is used as a patch rather than an overall way to solve the problem.


Clearly, something needs to be done, if not industry-wide then at least within organizations struggling with these inaccuracies and inefficiencies. One such solution is outsourcing medical claims processing to a reliable, experience provider. With the use of leading-edge technology, a processor can convert a multitude of medical form types into high-quality images and data. Then the medical claims information can be delivered in the Electronic Data Interchange (EDI) standard electronic format to any back-end system.


Outsourcing medical claims processing offers many advantages, including increased profits through expedited claims processing, reduced transaction costs, less time and money spent on overhead functions (that have little actual impact on the outcome of medical claims), secure online access for exception management, HIPAA compliance and protection and audit trails for real-time reviews and process transparency. All of these elements can address that tendency for error in organizations that choose to implement such a solution.

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