Sharing is Caring: Why Business Process Consulting Will Continue to Grow in Healthcare

By Denny Hammack

When you’re in the business of providing Enterprise Content Management (ECM) solutions for companies across a wide spectrum of industries, you learn a lot. One of the first – and most important lessons – is that no matter how much you talk to professionals in those different arenas, you can never know every detail they know. This is certainly true in healthcare.

You know from your own experience that there are all kinds of doctors. While the majority of us may see a generalist for our yearly check-up, we know that should the need arise, we can visit any number of specialists, from orthopedic surgeons to allergists to OB/GYNs. There is no shortage of options.

As ECM purveyors, we at FileSolve believe that technology (i.e., software) is the second most important tool we provide. The first is good, old-fashioned interpersonal communication. Our ability to come into an organization and listen to the people there is the most critical aspect of any engagement. Here, let’s focus on healthcare. As I mentioned, we know a lot about ECM, but not as much about healthcare as the people who work in it. The opportunity to exchange information about the two is where the magic happens. We bring ECM knowledge, and individuals from the medical community bring healthcare knowledge. That interchange is at the heart of what we do as consultants.

The world of healthcare is changing. One of the primary ways it’s changing is with the adoption of what’s called ICD-10, or International Classification of Disease, Tenth Edition. Just how significant a change is it from its precursor, ICD-9? Well, ICD-10 diagnosis codes can have anywhere from three to seven alphanumeric digits that combine to make more than 69,000 unique diagnosis codes.  ICD-9, by contrast, consisted of only three to four numeric digits that combined to make about 4,000 unique procedure codes. That’s a difference of 65,000 codes! And that’s just the beginning.

Consider, too, that any medical office or entity covered by HIPAA must be able to successfully conduct health care transactions using these new codes. In fact, the codes used under ICD-9 classifications have been invalid since last October! Put simply, ICD-10 coding was implemented to help improve clinical communication. It does this by increasing the amount of “descriptors” that can be used to describe a patient’s condition. Of course, expanding the number of codes so dramatically also increases the likelihood of keying errors and potential insurance payment denials.

One of the core benefits of using an ECM software solution is that it can, to a degree, minimize the likelihood of errors. Manual data entry can lead to all sorts of entry errors – especially with a likelihood of transposing 69,000 new codes. Relying on paper can also lead to misplaced or lost information, which can affect not only patient treatment, but insurance payment rectification. Helping medical professionals learn how to use ICD-10 coding and ECM together can go a long way towards improving healthcare for all.

Meredith Ritchie, Director of BPO Solutions at FileSolve, says, “Wherever possible, I consult with my clients to eliminate key entry and rely on straight-through processing (STP) to match claim data, payment data and the associated remittance detail.  STP, plus data extraction, automates the matching process and allows a staff to focus instead on clearing up any exception items. This is the key to increasing a provider’s revenue collection rates and providing a clear ROI.”

As our population grows and the medical systems we rely upon get more sophisticated, the need for clear, effective one-on-one communication will only get stronger. This is true both at the patient-provider level and when it comes to offering consulting services. In our case, we think specifically about helping healthcare facilities and systems better understand how ICD-10 coding implementation, for example, might affect their accounts payable department, claims processing and even compliance adherence.

No industry is ever static; change is constant. As the healthcare industry booms and shifts, it will only become more important that consultants of every variety do their best to help put their clients in an advantageous position. As consultants, our understanding of relationships, process strategizing and implementation effectiveness can go a long way towards providing those clients peace of mind. Looked at in this way, the prognosis for consulting in the near- and far-term is quite positive.           

Denny Hammack is the CEO of FileSolve, an industry-leading provider of electronic document management solutions. FileSolve provides software & traditional services to a wide range of industries and departments throughout specific U.S. Markets.

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