Claims management has traditionally been an area of tedium, conflict, confusion and aggravation for healthcare providers. Getting claims paid by the insurance company hinged on every “i” being dotted and every “t” being crossed.
That is still the case today, but vendors contend that their automated billing services and systems are making the process faster, easier and more accurate than ever. Whether information captured at intake is with a magnetic strip reader or document scanner, the integrity of that data is critical to the claim being paid the first time it is submitted.
Various companies have created applications and services to help providers streamline their billing operations by reducing the number of staff members dedicated to claims filing and by increasing the number of clean claims that get paid on the initial transmission. Historically a personnel-intensive activity, the new generations of billing systems are transforming claims management into a mostly automated process.
Sunnyvale, Calif.-based MedPlexus has designed a claims management system specifically for physician practices that are ready to move from manual to electronic billing. With a Web-based platform, the service is low-cost yet provides a high level of functionality, said CEO Chittaranjan Mallipeddi. MedPlexus serves as the “back end” of the patient data cycle, ensuring the integrity of the claim from intake.
“We take care of everything for them,” he said. “If there is a discrepancy in a bill, such as a payment of $200 for a $300 fee, some systems will automatically write it off as paid. Our system notifies the senior billers, giving them the option of pursuing the difference.”
The MedPlexus concept has been perfect for small practices like Ron Press’ four-physician clinic in Santa Fe, N.M. Press, a family practitioner with 20 years’ experience, started in private practice four years ago and adopted the MedPlexus system when he opened.
“We wouldn’t be able to survive in this climate the way insurers are,” he said. “It’s all put together in one big tight package. I can’t imagine using paper charts anymore.”
Yet despite more physicians embracing automation, paper is still common in many clinics. While the push for electronic health records will inevitably force all doctors to adopt automation at some point, transitional systems like Allen, Texas-based Innovative Card Scanning allow users to keep paper documents while scanning their contents into an electronic format.
The ICS concept provides security for offices not ready to completely commit to automation while speeding up the intake phase and alleviating errors that commonly occur during the keying-in process, said President Tim O’Brien.
“Our system grabs the image and scans it in, whether an insurance card or driver’s license,” he said. “It accelerates patient entry and clean claims processing, ensuring faster payment and fewer denials.”
The system also allows practices to evolve into full automation at their own pace, working with card-scanning kiosks and integrating with office management and electronic medical record systems.
Bryan Koch, vice president of Strategic Services for Duluth, Ga.-based Navicure, explains how the company’s clearinghouse program helps providers recoup money owed to them that often leaks out under manual or rudimentary electronic billing processes: “A patient checks in at the front desk, sees the physician, has a procedure and the total charge is $1,000, the fully integrated system determines that the insurer will pay $600 and there is a $300 deductible. The provider can then ask for the deductible at the time it is due.”
But for the system to work effectively, he said the three key domains must be in sync – front-end intake, electronic medical records and billing.
Louisville, Ky-based ZirMed promotes its system as giving providers the ability to “leverage the power of technology to cure administrative burdens and increase cash flow.” CFO and general counsel Jim Lacy contends ZirMed was the first company to file a claim over the Internet in 1999 and says it laid the foundation for Web-based billing transactions.
“ZirMed saw the opportunity to bring in the claim file and send it out to payers as a clearinghouse using Web-based technology,” he said.
“We have positioned ourselves as a comprehensive revenue solutions provider with $50 million in revenue and processing claims for tens of thousands of providers.”
Functionality of the company’s revenue cycle management system includes eligibility verification, credit/debit card processing, check processing, coding compliance, reimbursement management, electronic remittance advice, patient statements, provider credentialing and lock box services.
Rose Citron-Allen, practice lead healthcare consultant for Dayton, Ohio-based Teradata, specializes in analytics and business intelligence for the payer side, offering applications and data warehousing.
In an increasingly automated claims processing environment, payers are relying on operational dashboards to monitor the adjudication process, Citron-Allen said.
“The intent is to automate as much as possible with adjudication and 90 percent is now done without a human touching a claim,” she said. “We’re looking at patterns of data, monitoring output, enhancing adjudication rules and fraud detection is moving more toward real time. It’s like air traffic control, knowing hour by hour how things are managed.”
