Jun 17, 2022 | Partner, Trizetto Partner Solutions
We already know the trend toward automation in healthcare continues to grow each year. As technology continuously improves and the financial bar to entry lowers, the opportunities for healthcare providers and health plans to enhance operational processes grow as well. But even with the radical progress and the easier-to-use-than-ever healthcare operations software, many organizations fail to implement the solutions. It may be a lack of organizational enthusiasm or a simple need for more skilled internal technological expertise.
And while this is likely common knowledge at your organization, the amount of money wasted each year – driven by the absence of process automation – may not. Billions of dollars that could otherwise be spent on improving patient care and satisfaction, on building and rolling out new service lines, and generally improving healthcare operations are wasted every year. Billions.
The most recent CAQH Index reports $372 billion is spent yearly on administrative tasks throughout the US healthcare system. Of that amount, $39 billion of those administrative transactions are specifically tracked by the CAQH Index. “Of the $39 billion, the industry can save $16.3 billion, or 42 percent of existing annual spend, by transitioning to fully electronic transactions,” according to CAQH.
$16 billion in savings.
The current opportunity for savings driven by automated, electronic transactions within the healthcare industry is tremendous. That’s not to say the healthcare industry is doing nothing. CAQH found that healthcare organizations already save $122 billion annually thanks to process automation.
Even with the apparent success of automation, however, CAQH found the utilization, adoption, and growth of fully-automated processes year-over-year was stagnant or modest at best:
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- Eligibility and benefit verification remained steady at 84%
- Prior authorizations increased to 21% from 13%
- Claim status inquiry grew slightly to 72% from 70%
- Claim payment automation increased marginally to 71% to 70%
With the small and slow shift to the use of automated transaction processes in the healthcare industry, there’s a decided advantage–in time and money–to not automating many, if not all, backend operations. Doing so allows staff to focus on strategic initiatives, like building out new programs or service lines, rather than plodding through everyday tasks better tackled through repeatable processes supported by technology.
“The industry continues to make progress towards a more automated administrative workflow as transaction volume increases, new business needs and technology emerge, and health insurance benefit and payment models evolve,” CAQH explains in the report. Nevertheless, as mentioned earlier, the “progress” remains slow, like a river choked with debris.
Ironically, even as automated solutions become more abundant and easier to use, CAQH reports healthcare providers to perform more manual tasks today than in the past. With today’s technology-rich environment, there’s little reason for healthcare providers to input any type of care-related documentation by hand. That time can and should be better spent improving the healthcare experience for patients and their families.
It’s far past time to clear the detritus from the river. With the advantage of today’s technology, it’s easier to make the change when each of us plays a part in the cleanup.
Contact a TriZetto Provider Solutions representative today to learn more about automation-enabled technologies that can help drive efficiencies and increase revenue.
EZClaim is a leading medical billing and scheduling software provider that combines a best-in-class product with exceptional service and support. For more information, schedule a consultation today, email our experts, or call at 877.650.0904.
[ Contribution from the marketing team at TriZetto ]
Mar 10, 2021 | Cloud Security, HIPAA, Live Compliance, Medical Billing Software Blog
How Can You Avoid Phishing Scams?
Phishing is the fraudulent practice of sending e-mails or text messages claiming to be from reputable companies in order to persuade individuals to reveal personal information, such as passwords and credit card numbers. Scammers use e-mail or text messages to trick you into giving them your personal information, trying to steal your passwords, credit card account numbers, or Social Security numbers. If they get that information, they could gain access to your accounts. Scammers launch thousands of phishing attacks like these every day—and they are OFTEN successful!
The FBI Internet Crime Complaint Center reported that $57 million was lost to phishing schemes in one year. Scammers often update their tactics, but there are some signs that will help you recognize a phishing e-mail or text message.
How to Recognize Phishing Scams
First, phishing e-mails and text messages may look like they are from a company you know or trust. They may look like they are from a bank, a credit card company, a social networking site, an online payment website, or an app or online store. Phishing e-mails and text messages often tell a story to trick you into clicking on a link or opening an attachment.
They may:
- Say they have noticed some “suspicious activity or log-in attempts”
- Claim there is a problem with your account or your payment information
- Say you “must confirm some personal information”
- Include a fake invoice
- Want you to click on a link to make a payment
- Say you are “eligible to register for a government refund”
- Offer a coupon for free stuff
What are the Signs of a Scam?
- The e-mail says your account is “on hold because of a billing problem.“
- The e-mail has a generic greeting, “Hi Dear.” (If you have an account with the business, it probably would not use a generic greeting like this).
- The e-mail invites you to click on a link to “update your payment details.”
Your e-mail spam filters may keep many phishing e-mails out of your inbox, BUT scammers are always trying to outsmart the spam filters. So, it is a good idea to add extra layers of protection.
Four Steps You Can Take Today
- Protect your computer by using security software.
Set the software to update automatically so it can deal with any new security threats.
- Protect your mobile phone by setting software to update automatically. These updates could give you critical protection against security threats.
- Protect your accounts by using multi-factor authentication. Some accounts offer extra security by requiring two or more credentials to log in to your account.
- Protect your data by backing it up. You can copy your computer files to an external hard drive or cloud storage. Be sure to check with
your IT department and designated Security Officer before copying data to other locations.
What to Do If You Suspect a Phishing Attack?
If you get an e-mail or a text message that asks you to click on a link or open an attachment, first answer this question: Do I have an account with the company or know the person that contacted me?
- If the answer is “No,” it could be a phishing scam
- If the answer is “Yes,” contact the company directly using a phone number or website you know is real, NOT the information in the e-mail. Attachments and links can install harmful malware.
- If you think a scammer has your information, like your Social Security, credit card, or bank account number, go to IdentityTheft.gov. There you will see the specific steps to take based on the information that you lost.
- If you think you clicked on a link or opened an attachment that downloaded harmful software, update your computer’s security software. Then run a scan.
- Finally, contact your Security Officer and IT Staff Immediately.
What Can I Do to Ensure This Doesn’t Happen?
One of EZClaim’s partners, Live Compliance, will make checking off your compliance requirements extremely simple. They have a service that is:
- Completely online, our role-based courses make training easy for remote or in-office employees.
- Contact-free, accurate Security Risk Assessments are conducted remotely. All devices are thoroughly analyzed regardless of location. Conducting an accurate and thorough Security Risk Assessment is not only required but is a useful tool to expose potential vulnerabilities.
- Built directly into your portal, easily monitor where your workforce may be vulnerable with our Dark Web Breach Searches. Easily expose breach sources with ongoing searching of active employee email or domain ensuring continued awareness of potential breach exposure. Weekly automatic e-mail notifications if new breaches are discovered.
- Informational, and has short, informative, privacy awareness videos covering technical, administrative, and physical safeguards with topics such as Ransomware, Phishing, the Dark Web, Password Protection, etc. Delivered monthly with no logins required, empower your workforce to make conscious decisions when it comes to your organization’s privacy and security.
So, don’t risk your company’s future and avoid phishing scams especially when Life Compliance is offering a FREE Organization Assessment to help determine your company’s status. Call them at 980.999.1585, e-mail them at Jim@LiveCompliance.com, or visit LiveCompliance.com. For more specific information, e-mail support@livecompliance.com
ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call them today at 877.650.0904.
[ Article contributed by Jim Johnson of Live Compliance | Photo Credit: Shutterstock ]
