Introduction
Medical claims management is the one constant in the evolving industry of healthcare. It is the backbone of the industry that ensures that providers are paid for their services to patients. The existing methods in healthcare claim management are cumbersome with many moving parts. As a result, the process is prone to inefficiencies, mistakes, and delays which affect revenue cycles of providers. But automation of claims management in healthcare has emerged as a highly promising solution for all the existing problems.
Challenges with Medical Claims Management
The entire process flow of healthcare claim management involves the submission, processing, and reimbursement of claims for medical services. Efficient claim management in healthcare is not only necessary for the providers, but also for the overall patient experience. Let’s talk about some of the biggest and most common challenges in managing claims:
- Operational Overhead
Processing healthcare claims manually is cumbersome for both healthcare organizations as well as insurance companies. For providers, it involves coding the services and entering the charges for the same. For payers, processing a claim involves determining the extent of coverage appropriate for the services provided. Processing the claims manually is time-consuming and takes up a lot of resources for both providers and payers. Larger the organizations, greater the volume of claims to be sent and received respectively.
- Prone To Mistakes
This is one of the most common problems when it comes to medical claims. The nature of the process makes it highly prone to human errors. Any mistakes in data entry or coding lead to claim denials for providers, which in-turn involves an elaborate process of appeals. According to a report by the American Medical Association (AMA), coding errors cost the healthcare industry approximately $36 billion in losses.
- Delays
Delays in processing claims result in delayed reimbursements for providers. A delay can be because of some irregularities in claims, unusually high workloads, or changes in policies at the payer’s. They are disruptive to the overall revenue cycle management process.
Benefits Of Automation For Medical Claims Management
A healthcare claim management software that includes features for automation accelerates and streamlines all the activities in managing claims. Let’s explore in detail the advantages of using medical claim processing software for automation:
- Reduction of Mistakes
A medical claims software with features for automation improves the accuracy of the entire process of claim management significantly. Since it eliminates the need for human intervention in manual, repetitive activities, there are very few errors. As a result, the number of claim denials and inaccuracies in billing decrease sharply.
- Maximum Efficiency
A software for automating medical claims management increases the speed of all the processes involved in the claims lifecycle. In doing so, healthcare organizations are able to generate claims faster, and payers too are able to process them quickly and accurately. A software platform increases the volume of claims that can be handled by providers as well as payers, leading to timely reimbursements and a reduction in losses. As a result, there is higher efficiency and productivity.
- Reduced Overhead
The administrative overhead involved in managing claims manually is high both for providers and payers. Larger organizations that deal with more claims would need to spend more resources in ensuring accuracy of claims management. But using a healthcare claim management software for automation enables a smaller staff to do more work with greater accuracy.
- Optimized Revenue Cycles
Fast and efficient processing of claims is vital for good revenue cycles. A medical claim processing software directly helps in streamlining revenue cycle management at healthcare software development companies. By automating the workflows involved, this platform prevents losses for providers and helps payers identify incorrect or fraudulent claims better.
- Improved Patient Experience
Automating claims management leads to a more transparent and accurate billing process. Additionally, using a medical claims software also frees up time and resources for the medical staff to focus on patients. As a result, there is a marked improvement in the patient experience.
Elements of Medical Claims Management Automation
Key components of software for automating healthcare claim management include:
Claims Submission: Automated claim submission is faster and more accurate. Additionally, it also enables providers to verify if the claims are compliant with specific payer rules.
Claims Adjudication: For payers, the claims are adjudicated automatically as per existing policies. Automation speeds up adjudication and highlights any anomalies for subsequent manual verification.
Insurance Verification: This platform verifies patients’ health plans in real-time, minimizing the risk of claim denials.
Conclusion
Automation of medical claims management has a transformational effect on the organizations using it. It maximizes efficiency, productivity, and cost savings, while lowering the overall operational overhead involved. As the healthcare industry continues to adopt newer technologies, automating the processes surrounding claims management will be vital for evolving with any changes. The benefits of automation will ultimately be experienced by all stakeholders involved – the providers, payers, and the patients.
