Healthcare IT News - June 2008 - (Page 35)

www.HealthcareITNews.com ManageMent SolutionS June 2008 ■ Healthcare IT News 35 Claims processing segment poised for growth Payers, providers on a quest to make payments faster, more efficient. By JoHn andrEws, Contributing Editor processing centers have been a fertile area for tales of financial woe – fueled by incidents like backlogged accounts receivables, repeated claim denials, lengthy adjudication disputes, convoluted logistics, procedural redundancies and miscommunications with payers. But time (with some help from automated claims filing systems) is apparently healing those wounds. By utilizing some of the electronic billing software available today, providers have the power to cut down or eliminate many of the frustrations that have plagued them for years, claims processing authorities say. “Providers now have the opportunity to become a lot more efficient at claims Today, providers have the power to cut down or eliminate many of the frustrations that have plagued them for years, processing,” said Michael Miscoe, national claims processing authorities say. advisory board member for the American “There are only pockets of it right now,” Academy of Professional Coders. “It is an practices still prefer to file paper claims, she said. “Currently it can only be done opportunity in the sense that the transi- Miscoe said. “For some practices it just doesn’t make around one type of transaction or service. tion from paper to electronic billing is The industry will get there in a few years, not automatic. Providers need to do their sense to bill electronically,” he said. Miscoe doesn’t see the situation chang- but it needs to work through manual prohomework first – you don’t just press a cesses and manual intervention. Fraud is a magic button and expect the rest to “any number of things huge issue and there needs to be a way to take care of itself.” detect it without interruption.” Electronic billing is not exactly a will slow down the Aside from adopting new technology, shiny new technology – most hosprocess. internally, there O’Hara says providers need to take a hard pitals and physician practices are are normal billing look at their processes to see where they filing cyber claims to some degree problems that create can improve. and most payers have some sort “It’s really about changing the workflow of automated claims intake. But Michael Miscoe errors.” – truly understanding the goal and workchallenges exist in older generations of – Michael Miscoe ing backwards,” she said. “It doesn’t neceselectronic filing systems that can delay claim turnarounds, Miscoe said, such as ing much in the next five years, though sarily mean adding to the workflow, but extraneous documentation that has to be he strongly favors adoption of real-time enhancing it. Technology is not the differclaims adjudication, a technology that entiator – it is more about the products handled manually. “Any number of things will slow down allows the provider to bill at the point of and services you offer.” the process,” he said. “Internally there are service. Currently used by large health normal billing problems that create errors. systems such as Louisville, Ky.-based claiMS ‘indigeStion’ The new CMS-1500 form for Medicare Part Humana, real-time claims adjudication To be sure, “new platforms haven’t solved B has a specific way to print and unless the gives billers precise, up-to-the-second old problems” for providers in some instancsoftware vendor has adhered strictly to that information about the total charge sub- es, agrees Elizabeth Hart, senior director of specification, the carrier can’t scan it. If they mitted, allowable charges and patient healthcare solutions for Cambridge, Mass.print on high-density laser sheets the claim liability portion, including co-insurance, based Pegasystems. can’t be scanned. Stapling attachments to deductibles and co-payments. “Some new systems have features missWhile observers predict real-time ing and some have new product and benclaims also causes problems.” If a claim can’t be scanned or processed claims will eventually become widespread efit designs that are difficult for adjudicaelectronically, the information has to be throughout the industry, its adoption is tion systems to handle,” she said. “I know of re-inputted on the payer end, which adds minimal at this point said Maggie O’Hara, organizations that have to purge systems of a whole other time-consuming layer to the group vice president of marketing and existing benefit designs to get new features billing cycle. These difficulties are part of product management for Stamford, CT- involved.” the reason why a lot of small physician based IVANS. Salil Shinde, Pegasystems’ product manistorically, claims H agement director and claims specialist, adds that constantly evolving policies and procedures are further taxing outmoded systems. “The heart of the issue is that business comes back with so many changes on the adjudication process, which adds layers of code to archaic systems,” he said. “The result is that IT departments have requests piled up on their plates for months.” Though the movement is toward real-time claims processing, Hart contends the issue “isn’t real-time or batch processing, but the capability of the system to digest the claims coming through. Even in real time, they still stack up, so the issue is getting them to come in seamlessly.” proceSS integration As the lifeblood of healthcare revenues, claims processing, like various other departmental functions, has operated within its own sphere, independent of accounting, purchasing, operations and clinical services. Ultimately though, it needs to be folded into a single workflow, says Dawn Burris, vice president of integrated health solutions for Newport Beach, Calif.-based TriZetto. “Integrated health management is the goal,” she said. “There are ways for payers and providers to come together to make it simple for the small provider to do real-time point of service.” Burris is optimistic that the industry is already on the verge of mass adoption of real-time claims adjudication that will merge together all clinical, financial and administrative transactions into a single integrated workflow between payers, providers, employers and health plan members. “This is what needs to happen if we are to solve the healthcare affordability crisis,” she said. ■ more At HealthcareITnews.com e Connect: ClAims 0608 ● Varian Medical Systems The ARIATM oncology information system gives cancer care professionals the specific tools they need to provide quality care to patients. With ARIA, clinicians can instantly access each patient’s medical information and images whenever and wherever they’re needed. All patient information is aggregated into a single, oncology-specific electronic medical record — supporting a truly paperless oncology department. ARIA uses the standard HL7 message format to freely exchange patient information with other medical departments so system integration is straightforward, and enterprisewide connectivity is assured. Vickee Irvin 3100 Hansen Way Palo Alto, CA 94304 T: 650–424–5768 • F: 650–424–6852 E: vickee.irvin@varian.com www.varian.com CardIology Continued from page 34 mCKessoN Horizon cardiology Horizon Cardiology is a complete, integrated cardiovascular information solution for cath, hemodynamics, echocardiography, vascular ultrasound, nuclear cardiology and ECG. It meets the full spectrum of needs for healthcare organizations with diagnostic digital image management, archiving, procedure reporting and workflow management. pHilips HeAltHCAre agement, analysis and reporting solution that organizes and provides access to images and data from key cardiology subspecialties. prosolv (fujifilm) workflows. the application supports protocols, ACC criteria and disease and population management activities while offering seamless integration with imaging systems and monitoring devices. ge HeAltHCAre proSolv cardiovascular ProSolv Cardiovascular delivers a one entry point to real-time image viewing and reporting for clinicians and staff. Its interoperability eliminates data input duplication, reducing human error potential and increases workflow management efficienc, leading to higher departmental throughput. ■ more At HealthcareITnews.com e Connect: CArDiology 0608 ge Healthcare’s cardiac Solutions GE Healthcare’s integrated cardiac solutions provide clinicians with patients’ medical data and images, helping to predict, diagnose, treat heart disease, monitor and inform. Xcelera Multimodality information Management Philips Xcelera is a multimodality image man- ● www.HealthcareITNews.com HealthcareITnews.com www.varian.com HealthcareITnews.com

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Healthcare IT News - June 2008

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