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How Medical Claims Processing Software Lowers Costs

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Medical claims processing can be a costly and time-consuming chore for today’s health-care and medical professionals. It’s a daunting task, but it must be done accurately and efficiently.

Here’s the good news — today’s medical claims processing software is easier to use and more effective than it ever has been.

The added bonus? It actually lowers costs.

Manual Claims Management Costs More

Organizations that are filing medical claims manually are spending $4 more per transaction! Depending on the size of the organization that really adds up quickly.

Once you factor in the cost of labor on top of that, the costs get even higher.

On the bright side, by switching over to a more automated, electronic medical claims management system,  the savings can happen almost immediately.

The medical and health industry simply can’t afford to do things the old fashioned way anymore. 

Cutting Costs With Medical Claims Processing Is Essential

In today’s market, it’s not just a good idea to cut costs wherever possible — it’s essential. It’s what’s necessary in order to stay competitive and stay in business.

If a doctor can’t provide efficient administrative solutions, they simply can’t do their job in the health and medical field effectively.

Especially with insurance policies changing constantly, control must be taken over every aspect that can be controlled.

Much of the cost comes from the administrative department. Every dollar that is spent in the claims process matters now more than ever.

Why Are There Providers Who Still Hold Out?

Just last year, HIMMS reported that a full 31% of all medical providers were still handling denied claims using manual processes. That’s a fairly decent chunk of the market that is losing money and time.

Why on earth would any of today’s providers resist the move over to automated medical claims processing?

They’re moving slowly and they’re shopping around essentially. The same report found that 60% of those who are still holding out a plan to switch over within about a year.

In the meantime, of course, they’re losing money, not to mention wasting a lot of time. They simply do not realize how much better their claims processing could be. 

Healthcare Providers Are Losing More Money Than They Think

The case for faster adoption over to automated medical claims processing isn’t just about the $4 per file. Manual processing comes with an even bigger price tag than many providers are realizing.

A healthcare payer looks at the auto-adjudication (AA) rate. This refers to the percentage of claims that automatically pass through the system with no human intervention. 

There are situations that have been reported where the cost of a human filing a claim surpassed the payout. If that happens enough times, you can only imagine how expensive that can get for everyone involved.

According to Pricewaterhouse Coopers, inefficient claims processing was the second biggest factor driving up medical costs overall back in 2009. The amount totaled a whopping $210 billion annually. 

Thankfully, better and better technology is available all the time. More healthcare professionals are adopting the latest software technology to streamline the process.

Most importantly, switching over saves money.

Costly Errors Are More Likely With Manual Processing

Many of these happen when entering inaccurate billing codes. When that happens, claims are less likely to get paid in a timely manner.

The chances that a human will make that error far surpass the errors that an electronic medical claims processing system can make. Even when information is electronically added to CMS-1500 and UB-04 paperwork, it’s still less likely that errors will occur.

However, it’s not the optimal automated process.

Electronic Medical Processing Has Come A Long Way

Electronic medical claims processing is definitely not new technology, but it’s changed a lot over the years. Optical Character Recognition (OCR) is an amazing advancement.

It decreases the chance that costly mistakes are made when coding and filing.

OCR scans documents, electronically isolates, and then records the information contained in the fields. It can also auto-fill information.

In this process, a human is still involved, but it’s to review the processing and ensure accuracy, not be solely responsible for it. If a medical code is not properly recorded, the error is reported by the specialist who is filing the claim.

This check and balance process saves time, money, and frustration for medical and dental professionals. It’s so effective that they simply cannot afford not to make the switch to this type of system.

Resubmitting Is Less Labor Intensive With Automatic Claims

Mistakes and coding errors happen when filing claims. It’s a reality in the medical profession, but that doesn’t mean that they have to take a long time to fix.

Not only can you catch errors faster with medical claims processing software, but they’re less likely to happen in the first place.

To correct an error on a piece of paperwork from an insurance company once it’s been submitted is a time-consuming process.

If you make an error with claims software, you have help at your disposal. Many medical claims processing software companies provide 24-hour assistance. There are also online resources available. 

An insurance company is not going to give anyone helpful call or talk to them in the middle of the night when a claim hasn’t used the right code. The error will simply not be remedied within a timely manner, especially by today’s standards.

Making The Switch Is Simpler Than You Think

It’s only a matter of time before the entire health and dental industry is taking advantage of automated medical claims processing. The reduced financial burden that using this system delivers makes it worth it.

More and more professionals are making the switch and they’re happy with the results. 

The key is to choose the right software company. There are better options all the time and not every company is the right fit.

They have to be able to be there through the switch every step of the way. 

With the right software solutions and support, switching to an electronic claim processing system doesn’t have to disrupt business.

Contact a company like Apex EDI to schedule a free, live, and personalized demonstration



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