(Finally) Introducing the Era of Fully Automated Claims Processing

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Photo credit: Depositphotos

By Steven Thill, Partner Executive, Healthcare, Ricoh USA, Inc. and Rory Fitzpatrick, Partner Executive, Healthcare, Ricoh USA, Inc. 

Health information is some of the most sensitive and carefully protected information that virtually every person generates. In a deeply interconnected world, safeguarding that information is even more vital and challenging. At the same time, we are living in a world where people expect any- and everything to be immediately at their fingertips, a simple search away. 

Healthcare IT is tasked with a difficult balancing act between secured processes and seamless access, so they can protect sensitive information while delivering a first-class patient experience, improving care outcomes – and healthcare facilities’ bottom lines.
A major area where many healthcare organizations can improve on this front is by automating claims processing. Intelligently applied automation can save $13.3 billion per year – that’s a third of annual healthcare administrative spend. Claims processing is particularly ripe for automation, with 94% of providers reporting being heavily dependent on manual processing for claim submission and follow-up before the pandemic and 60% reporting being heavily dependent on manual processing for claim status and payments. At a time when many workers are minimizing or entirely avoiding going into the office, the need to move beyond manual processes and be able to get patient information quickly, accurately and directly into secured, accessible, interoperable repositories is vital.

Efficiency, accuracy and transparency in the claims process can make all the difference in a patient’s healthcare journey, as well as their perception of an organization.If a patient can quickly find out how much money they owe, they can feel a sense of security that their provider understands what’s important to them and wants to enter into an honest partnership with patients to help improve patient experience.

Faster claim processing requires interoperability, and providers are increasingly embracing digital, automated solutions, which enable back-office employees to work remotely and maintain productivity. The best of these can classify, extract and index information and automatically route it to the appropriate patient file or workflow within an organization’s enterprise content management (ECM) and electronic health record (EHR) systems.

How one medical center embraced automation and improved processing time 400%
Recently, a major medical center was manually processing more than 1,000 claims correspondences each day, spanning more than 200 document types. The average processing time was 20 minutes per document, a pace that risked missed deadlines, denied authorizations and delayed payments. The resulting processing backlog often stretched to two weeks. By partnering with Ricoh and leveraging its Patient Information Management Service, the medical center introduced intelligent, holistic automation, and the average document processing time improved 400%. Correspondences were consolidated into 22 document types – a nearly 90% reduction – and a secured browser-based portal was instituted to empower staff to work remotely and seamlessly during the pandemic. Today, claims are typically processed in two days or less.

What to look for in an automation solution
How can your facility drive results like that? A great starting place is finding a knowledgeable partner who understands your operations and how they compare to similar organizations’ as well as emerging trends. The ideal partner takes a holistic look at all of the processes that go into patients’ healthcare journeys and the administrative back-end for the seamless, secured flow of information where it needs to be, when it needs to be there, in the form in which users need it. Eliminating manual touchpoints reduces errors, re-work and turnaround time.

Piecemeal automation provides piecemeal improvements, while an end-to-end approach allows the benefits across different workflows to compound one another, further enhancing the patient experience and helping drive both better outcomes and increased satisfaction, in addition to increased productivity and cost savings. 

Don’t be afraid to ask a potential partner directly how their proposed solution benefits your patients and/or your administrators. 

If they answer quickly, confidently and comprehensively, that’s a good sign that they are focused on what’s important to your organization – and it could be the start of a beautiful partnership.

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