Check out the latest report on Automatic healthcare remitance processing by Gordon Sellers - Director, Healthcare and Medical Banking Solutions at system ware.
Automating healthcare payment and claims remittance processing systemware's medical banking automation summit report
1. Automating Healthcare
Remittance Processing
TAWPI
Healthcare Payment Automation Summit
Chicago 9/14/09
Gordon Sellers
Director, Healthcare & Medical Banking Solutions
gordon.sellers@systemware.com
2. Providers Landscape
• 7000+ hospitals, clinics, surgery centers, etc.
• 450,000+ physicians in private practice
– Half in practices with more than 5 physicians
• Average 30% first pass denial rate per charge code
– Half due to eligibility issues
• Average administrative cost per submitted claim
– $10 to $12
• Average total administrative cost per secondary claim
– $8 to $10
• Administrative cost for appealed claims
– Can surpass $60
Source: Healthcare Financial Management Association
3. Why Medical Banking
• Currently banks provide:
– lockbox services such as deposit of payments
– imaging of checks
– imaging of paper EOB (some)
• What banks could provide:
– Data conversion
• of paper EOB’s into EDI 835 files for posting to Provider systems
– Balancing
• of claimed amount with paid amount minus any adjustments
– Process automation
• to reduce error rates and processing cost for Providers
– Visibility
• into the relationships between claims, payments and deposits
• Transactional discipline
5. Extended HC Lockbox
• Medical Banking Application
– Capture & indexing of EDI 837 files
– Converts paper EOB’s into EDI 835 files
– Capture & indexing of EDI 835 files
– Automatic matching between EDI 835 files & EDI 837 files at the
claim and/or service line level
– Output of targeted file for upload into PMS at Provider
– Secondary / Tertiary claim preparation & submission
– Exception Management workflow queues
– Reporting
• Bank Administration Portal
– Set up & Administration of Providers
– Transaction Billing Report
6. Online Providers Experience
• Provider Portal (Bank Branding)
– Manage processing exceptions
• 837 /835 matching
• Secondary match to primary EOB image
• Secondary match to 835
– Download posting file
– Research denials for resubmission or
secondary
– Dashboards and report generation
14. Medical Banking
• What banks SHOULD provide:
– Data conversion
• of paper EOB’s into EDI 835 files for posting to Provider systems
– Balancing
• of claimed amount with paid amount minus any adjustments
– Process automation
• to reduce error rates and processing cost for Providers
– Visibility
• into the relationships between claims, payments and deposits
– Transactional discipline
• banks have are good at this healthcare (providers) are not