Three Benefits of Switching to Electronic Claim Attachments

Three Benefits of Switching to Electronic Claim Attachments

Switching to Electronic Claim Attachments

One of the biggest strains on the healthcare industry remains its reliance on paper and manual processes. The combination often adds up to human errors and costly denials, which require exponentially more time and resources to resolve, if left unchecked.

Among the manual processes most challenging to manage is claim attachments, which demand considerable time for teams to review requirements, collect and send necessary documentation, and complete follow-up procedures. According to the CAQH Index, the medical industry spent $590M annually exchanging attachments, with some providers spending anywhere between 10-30 minutes manually submitting an attachment to a payer.

An electronic claim attachments solution bolsters efficiency, strengthens cash flow, and significantly reduces AR days. If you’re considering how such a solution could benefit your healthcare organization, read on to learn about three key areas it can improve.

  1. Simplify document + data exchange with payers

Despite technological advancements, providers still face a complex, manual environment for payer document and data exchange. Electronic claim attachments can help ease long-standing friction points between providers and payers by automating supporting documentation submission. It’s a win-win for providers and payers as workflow efficiency can be maximized and claims adjudicated more swiftly and correctly.

  1. Support frictionless and remote workflow

Processing claim attachments becomes exponentially more time-consuming and expensive because of its paper-based nature and the need to keep up with ever-changing payer rules and requirements. Shifting to electronic claim attachments can provide flexibility to ensure your billing team can continue to operate effectively even in disruptive times. It not only saves time and money each day but it’s also proved critical during events like Covid-19, allowing a divided workforce to still get the job done.

  1. Reduce cost to collect

Not all clearinghouses are created equal—the right partner fervently seeks opportunities for staff to work smarter, not harder. Automation and scale are key elements to not only maximize efficiency and accuracy but also reduce a provider’s cost to collect.

Although electronic attachment adoption remains low, there’s considerable benefit to implementation. While electronic transaction for claim attachments has not yet been federally mandated, the 2020 CAQH Index found the medical industry could save over $377M per year, helping organizations protect their bottom lines and provide more affordable care to their patients and communities.

Wrapping it up: taking the smarter approach to submitting attachments

Providers are all under cost and reimbursement pressure and the need for smarter, purpose-built automation is the secret ingredient for remaining in the black. Electronic claim attachments are a simple way to take the administrative waste out of your processes, prevent costly denials and accelerate cash flow, all the while supporting a remote workforce.

Looking for a smarter, simpler way to manage claim attachments and streamline workflows? Find out how Waystar can help automate the process, reduce denials and accelerate reimbursement. Visit Waystar.com.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

Healthcare Loses Billions Due to Over-Reliance on Manual Tasks

Healthcare Loses Billions Due to Over-Reliance on Manual Tasks

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:

      • 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 ]

How to Reduce Back-Office Denials with a Better Patient Access Solution

How to Reduce Back-Office Denials with a Better Patient Access Solution

A version of this guide to reducing back-office denials originally appeared on Waystar’s blog.

The last few years have been hard for just about everyone involved in healthcare, and not just because the revenue cycle has grown more complex. According to data from the Bureau of Labor Statistics, people on average now hold 12.4 jobs from age 18 to 54—nearly half of which are held before the age of 25. And that equates to just as many changes in their insurance coverage. Providers in turn must struggle to keep up with their patients’ seemingly ever-changing eligibility status, along with the details of what coverage is offered per level for a variety of payer plans. All that means it’s more challenging than ever to manage just about every aspect of the revenue cycle, and denials are no exception.

A recent MGMA poll found 69% of respondents had seen a noticeable increase in denials in 2021. Among those respondents, the average increase in denials was about 17%.  And while there are plenty of reasons to explain the increase, we took the opportunity with our upcoming white paper, “Supercharge eligibility + estimates with a better payer intelligence engine,” to assess how eligibility-related denials factor into the equation.

How eligibility issues stir up more denials

Some of the results produced while developing that white paper were striking. When benchmarking denials for two similarly sized health institutions (both with similar patient populations and payer mix) we discovered a sizable difference in denial rates, one that indicated the first provider had processed millions less in denials. Further analysis revealed this provider dealt with roughly 35% fewer denials, which ultimately helped contribute to an additional $3-4M in revenue.

Generally, we expect such a discrepancy to be explained by a handful of familiar factors: a low clean-claims rate, an abundance of late filing or an escalating number of appeals left unattended to—issues normally associated with back-office management. But in this case those common factors did not dominate the narrative. Instead, the following stood out as the top drivers and differences between the two:

  • A $39M difference in denials for patients identified as “not eligible”
  • A $34M difference in denials related to coordination of benefits
  • A $4M difference related to benefit maximums being exceeded

When we began to examine those discrepancies more closely, it became clear that there really wasn’t a back-office problem at all. In fact, client processes were considered quite lean and operated with consistent accuracy. Instead, problems were being generated much earlier in the rev cycle. By the time registration, scheduling and services had been rendered, there had not been notable mitigation to denial risks that should’ve been flagged. And with ever growing payer payment adjudication cycles, it seemed a steadily increasing denial rate was inevitable.

Looking for a root cause

In a study of Waystar clients, we found more than 10% of all registrants selected the wrong plan, and up to 35% of accounts triggered some kind of eligibility alert that indicated a potential denial risk. In other words, a significant portion of denials are caused by eligibility issues, one that could have been identified well in advance of them becoming problems. Finding other payers on file, replacement plans, CHIP, dental-only coverage and many other risk categories were simply not captured or flagged, which would have allowed end users to remediate the risk before a patient had even arrived for their appointment.

But what makes identifying these risks such a challenge? Ultimately there’s more to the problem than administrative oversight. The electronic data interchange (EDI) that makes modern eligibility solutions possible often includes message segments, plan codes and other critical identifying data that needs to be normalized and extracted. But that’s not possible without the right tools. If your front-end solution is not effectively crawling eligibility responses for risks like these, it’s time to upgrade your toolset and update your strategy.

Eligibility related denials are not always caused by issues in the coverage detection process, either. When it comes to common, multi-payer scenarios, benefit levels and coordination regularly cause problems in the claims adjudication process and ultimately have a significant impact on denial rates.

Older EDI solutions do not fully comprehend payer logic and often have a hard time identifying levels of coverage across different services. It’s no longer possible to rely on something like a ‘single STC 30’ EDI call to yield the benefit it (literally) once did. Now these benefits must be presented in a manner that lets staff easily interpret coverage and realistically determine when to expect payment from the patient and payer.

Wrapping it up: developing a comprehensive approach

You could be missing your single largest opportunity to strengthen your revenue cycle without a comprehensive approach to patient access eligibility. And one of the most important aspects of a truly comprehensive approach is shoring up your front-end processes to reduce the number of issues a claim might encounter as it moves downstream through the revenue cycle. Not only does this enhance the patient experience, it steadies revenue flow as it cuts down on the sort of trouble that would otherwise further drain staff time and resources.

Check out our most recent whitepaper, “Supercharge eligibility + estimates with a better payer intelligence engine,” for a more comprehensive look at what we’ve covered here. If you’re ready to tackle the challenges afflicting your front office, check out Waystar’s Financial Clearance solutions, which offer a smarter, simpler way to streamline areas like eligibility verification and prior authorization.

Join Waystar + EZClaim on July 14th to learn how to outsmart your denials.

Smartphone Apps and Best Practice to Reduce Risk

Smartphone Apps and Best Practice to Reduce Risk

There are many benefits to smartphones in the healthcare industry, however, there is also huge potential for HIPAA violations of patient privacy to be violated. It’s important to know what risk is associated with smartphones and other mobile devices.

CISA, or Cybersecurity and Infrastructure Security Agency, says “Mobile apps may gather information from your mobile device for legitimate purposes, but these tools may also put your privacy at risk.”

So, what are the risks associated with mobile device applications?

Apps are a convenient tool to access the news, get directions, or pick up rideshare, but these tools may also put your privacy at risk.

CISA says, when you download an app, it may ask for permission to access personal information—such as email contacts, calendar inputs, call logs, and location data—from your device. CISA goes on to say, “You should be aware that app developers will have access to this information and may share it with third parties, such as companies who develop targeted ads based on your location and interests.”

How can you avoid malicious apps and limit the information apps collect about you?

First, it’s helpful to reiterate that employee devices are for work purposes only. Therefore, applications on your workplace devices, including mobile devices must be approved by your Supervisor and must follow device guidelines set in place by your organization.

Employees must refrain from downloading, installing, and using apps such as social media platforms. Therefore, employees should refrain from posting, commenting, or sharing patient information on social media including patient names, photos, and descriptors that would identify the patient.

What steps can you take to secure data on your mobile devices?

  1. When using a public or unsecured wireless connection, avoid using apps and websites that require personal information and turn off Bluetooth.
  2. Avoid connecting your smartphone to any computer or charging station that you do not control. Charging stations are often found at transportation terminals and are not secure! Connecting a device to a computer using a USB cable can allow software running on that computer to interact with the phone.
  3. Do not leave your device unattended in public or in easily accessible areas.
  4. Ensure your device requires a password or biometric identifier to access it, so if is stolen, thieves will have limited access to its data.

If your device is stolen or misplaced, first, contact your IT administrator, supervisor, and/or designated HIPAA Security Officer immediately and notify them of the situation for immediate next steps. In general, it’s advised to, follow your organization’s Incident Response Policy immediately.

At Live Compliance, we make checking off your compliance requirements extremely simple.

    • 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, including those such as Password Protection.
    • Policies and Procedures are curated to fit your organization ensuring employees are updated on all Workstation Use and Security Safeguards in the office, or out. Update in real-time.
    • Electronic, prepared document sending and signing to employees and business associates.

Call us at (980) 999-1585 or visit www.LiveCompliance.com.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

[ Contribution from the marketing team at Live Compliance ]

The Devastating Effects of Social Media in Healthcare

The Devastating Effects of Social Media in Healthcare

HIPAA Social Media Do’s and Don’ts in Healthcare

There are many benefits to social media in the healthcare industry, however, there is also huge potential for HIPAA violations of patient privacy to be violated on social media networks.  The Privacy Rule protects All “individually identifiable health information” held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper or oral. The Privacy Rule calls this information “protected health information (PHI).”

Did you know that more than 71% of recorded data breaches in the healthcare industry are attributable to employee actions?

The most important rule is to never share Protected Health Information or Personally Identifiable Information on social media. Social media may include personal blogs and other websites, including Facebook, LinkedIn, Twitter, YouTube, or others of the like.

A few common identifiers include but are not limited to:

    • demographic data
    • medical histories
    • test results
    • insurance information
    • and other information used to identify a patient or provide healthcare services or healthcare coverage.

What is a breach and what can I do to avoid it?

 A breach is, generally, an impermissible use or disclosure under the Privacy Rule that compromises the security or privacy of the protected health information. This means employees should refrain from posting, commenting, or sharing patient information on social media including patient names, photos, and descriptors that would identify the patient.

What is considered identifiable information?

The most common social media HIPAA violations include:

    • Posting of images and videos of patients without written consent
    • Posting of gossip about patients
    • Posting of any information that could allow an individual to be identified
    • Sharing of photographs or images taken inside a healthcare facility in which patients or PHI are visible
    • Sharing of photos, videos, or text on social media platforms within a private group

“Friending” patients on social media websites is also strongly discouraged. This can lead to accidental identifying of patients, especially if your place of work is listed in your profile and accidental ‘discussion’ about the patient’s care. Therefore, employees in inpatient care roles generally should not initiate or accept friend requests. Do not enter into social media discussions with patients who have disclosed PHI on social media.

Employees should also refrain from messaging or texting PHI or PII on social media or messaging applications not approved by your organization. In general, no personally identifiable health information should be sent in any manner which does not ensure communication encryption in transit and at rest.

So, what do you do if you think you may have exposed a patient’s protected health information or personally identifiable information?

In general, it’s advised to, follow your organization’s Incident Response Policy immediately and notify your supervisor and/or designated HIPAA Security Officer for immediate next steps.

At Live Compliance, we make checking off your compliance requirements extremely simple.

    • Reliable and Effective Compliance
    • 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.
    • Policies and Procedures are curated to fit your organization ensuring employees are updated on all Workstation Use and Security Safeguards in the office, or out. Update in real-time.
    • Electronic, prepared document sending and signing to employees and business associates.

Don’t risk your company’s future, especially when we are offering a free Organization Assessment to help determine your company’s status. Call us at (980) 999-1585, or email me, Jim Johnson at Jim@LiveCompliance.com or visit www.LiveCompliance.com

For more information about DarkWeb breaches please contact us at (980) 999-1585 or email us at support@livecompliance.com


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.