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Most hospitals still wasting time manually following up on insurance claims
Despite the availability of services that automate claim follow-ups, most hospitals continue to outsource the services or use manual approaches, according to a survey conducted by Recondo Technology.
“Many hospital IT departments have been overwhelmed by the requirements of updating their electronic health record and adopting ICD-10, and as a result they haven’t taken a hard look at how automation could help the financial side of their businesses,” Jay Deady, CEO of Recondo, told HCB News.
Over half of the 80 health care financial professionals involved in the survey reported that their hospitals perform claim follow-ups manually. According to industry estimates, the manual approach can cost between $2.75 and $3.25 per claim, but 70 percent of the respondents stated that the actual cost is $4 per claim, which is 33 percent higher than the average estimate.
In addition, claim follow-up are usually performed by back-office staff over the phone and they can't review more than three or four claims at a time, depending on the payor's rules.
When a hospital outsources the services, it does lessen the burden on the hospital staff, but it is only cost-effective if the third-party service has exclusive access to payor data.
When hospitals send an inquiry about a claims status, the payor's response is called a 277 transaction. The problem is that the response usually only tells them whether the claim was denied or approved and does not give a reason, so the hospital has to do more work to get paid.
The rest of the respondents either use the 277 transaction set — 4 percent — web-sourced data taken from payor websites — 12 percent — or none of those methods — 31 percent.
Hospitals are now able to use automated processes called exception-based processing to get the status of claims from payor websites and generate a list of accounts with "approved" or "denied" statuses.
Now that the hospitals have made their investments in EHRs and are transitioning to the ICD-10 code set, they are looking at how to create a "touchless" billing process from patient intake all the way through to claims adjudication, wrote Deady.
The exception-based processing that uses Web-sourced data can immediately remove over half of the "soon-to-be-paid" claims from the work queue, and free up staff for other duties, which Deady said saves the hospital money.
