We're pleased to have completed a digital interface for receiving electronic medical bills and supporting documents with strategic partner drchrono, a national leader in mobile, web-based billing, and electronic health record solutions for medical practices. Electronic billing (‘e-Billing’) expedites and ensures more accurate payments to health care providers, reducing billing errors and time consuming phone calls to payers inquiring about the status of bills. Our partnership with drchrono offers physicians a seamless billing process to submit bills with medical reports and other supporting documentation, including electronic receipt and delivery confirmation for billing to carriers not equipped to receive bills or documentation electronically.
iHCFA and drchrono are both leaders in applying technology that is intuitive, easy to use and high value without the large investments typically required to purchase and learn health
care software applications. This technology interface offers an end-to-end electronic billing process for thousands of drchrono customers. William DeGasperis, President and CEO of iHCFA stated, “We’re very pleased to have this interface completed and to be working with the talented group at drchrono.” iHCFA recently completed system enhancements that enable receiving all bills and documentation electronically, including billing to carriers that do not accept electronic attachments. “These enhancements let us offer our customers one
billing process for all of their claims, greatly simplifying their billing operations,” said Dr. DeGasperis.
Michael Nusimow, CEO of drchrono stated, “Electronic submission of bills and attachments
provides another big step forward for drchrono customers, who already lead the health care industry using our mobile technology to manage clinical care, communicate with patients, and manage their business. We can now offer a truly paperless billing process, even for the paper-intensive medical bill processing interfaces of the Personal Injury marketplace,” he said. “The investment both organizations have made in e-Billing will have great benefits for thousands of
our health industry customers located across the country.”
iHCFA is at the forefront of electronic bill and claims processing technology. iHCFA has extensive domain expertise in both the provider community and the insurance industry. Our first e-billing solution went live on July 1, 2000 and provided immediate application of web-based claims processing that was productive and efficient – a major technology
accomplishment thirteen years ago. The system practically eliminates lost and
incomplete claims for complex personal injury billing where medical documentation is required.
For additional information please visit www.iHCFA.com or call 973-795-1641.
drchrono focuses on Apple's iPad, iPhone and cloud computing to build a better healthcare experience. The company offers a free EHR platform built on the iPad that is Meaningful Use certified. drchrono is also the first iPad EHR to implement real time clinical speech-to-text, patient eligibility checks, and iPad based medical billing. drchrono handles everything a doctor
needs to run their practice, including medical records, electronic prescribing, medical billing, and patient management. drchrono's iPad EHR app has been voted the top iPad EHR on the market by physicians in an independent survey by Black Book Research. For more information, visit https://drchrono.com
(Second of two discussions on data analytics investments. Contact us at: email@example.com or 888-488-2246)
Albert Einstein wrote, "Everything should be made as simple as possible, but not simpler."
Wise advice for professionals working to provide quality medical care and good business results in workers' compensation and auto personal injury lines. We all know the billing process should be simplified, but the process is not simple. A workers' compensation insurance carrier described to us their claims adjudicatioin algorythm as having exponential edits using more than 150 variables.
Are we making medical billing harder than necessary?
As discussed in a previous post, our industry is investing heavily in data analytics aimed at 'finding' and 'predicting' high cost cases and matching those with prevention and intervention. This will improve care and cost. But many denied claims are not hard to find.
For billing offices in both medical group practices and insurers, an 'adverse case' really is any claimant submitting a medical bill to a plan where the plan pays less than 100% of the bill after applying deductible and co-payments.
Many studies have measured and found 'adverse cases' account for 40 percent of total claims for personal injury insurance benefits, lower for health benefits. For high value business solutions, look at the most frequent reasons for denied claims. We think about adverse claims in three categories, each with very different causes and solutions:
- Claims with missing, incomplete or (and) invalid information;
- Claimants without insurance coverage (at the time service was provided, or for the specific services received, or with this insurer);
- All other administrative or medical denials or reduction of benefits.
Which denial bucket fills first?
The top rejection codes across health and personal injury claims are for missing or invalid information, bucket #1. Bills are rejected because they are unprocessable. These vary from demographic errors to missing signature or physician authorization.
For workers' compensation, Bucket #1 errors often are the result of missing medical documentation or reports. Given the abundance of paper processing of workers' compensation bills, these errors have costly implications; they can cause additional errors. Resubmitting a bill prior to receiving insurer determination increases administrative costs to both parties and causes a duplicate claim denial.
Claims without insurer coverage also have residence in the top reasons bills are rejected (Bucket #2). Although some are the result of generic denial codes or denial of non-covered services that warrant follow-up, most are errors that lead to telephone calls to insurance carriers. A surprising number of these calls are to carriers that don't insure the patient.
Our data show more than 20 percent of all medical bills we process are intially rejected for Bucket #1 and #2 reasons - they are errors.
Entire industries have emerged (e.g., legal, appeals consultants, data analytics) to deal with adverse cases that are either costly or thought to be candidates for appeal. We should start with billing automation. Amazingly, while more than 85 percent of health bills are processed electronically, most workers' compensation bills are not. Paper rules.
It need not be this way. More states have or are adopting electronic billing mandates for workers' compensation and auto personal injury lines. But compliance lags or exceptions rule.
Technology enables all personal injury bills to be processed electronically with medical reports and documentation included. Carriers using electronic billing for workers' compensation report up to 50 percent reductions in telephone calls relating to denied bills by providers. For insurers considering investing in data analytics to manage costly cases, electronic billing is low-hanging fruit.
Contact us for information about e-Billing at: firstname.lastname@example.org or 888-488-2246.
How might insurers evaluate the business value of having one fully electronic billing process for workers' compensation and auto personal injury claims?
Increasing investment in claims systems and data analytics by insurance carriers is the subject of lead stories in most insurance trade journals. Business analytics holds great promise for injury prevention, back to work programs and fraud prevention. But at a time when most workers' compensation and auto personal injury bills are transacted in whole or in part using manual (paper) processes, would electronic medical billing provide higher return on investment and better outcomes for claimants?
Douglas Hubbard, a published expert in business decision support, defines the value of information as "the cost of being wrong times the chance of being wrong." Consider two valid IT investment choices to improve results in workers' compensation: Project A, investing in predictive analytics (projecting what will happen), or Project B, establishing a paperless end-to-end electronic billing process?
For each strategy, estimate the chance of success, the business impact if the project is approved and either succeeds or fails, and the business impact of rejecting the project (the status quo with zero investment cost).
Applying Mr. Hubbard's measurement methodology to workers' compensation medical claims, consider four widely accepted conditions for good workers' compensation outcomes.
1. Electronic billing by insurers and medical practices reduces operating costs by 40 percent or more when replacing manual, paper processing.
2. Claims costs are higher if bill processing, treatment or payment are delayed.
3. Medical treatment costs constitute the majority of workers' compensation program costs and are rising faster, even in the presence of utilization and case management programs.
4. Failure to acknowledge, pay or deny claims is the top reason for insurer compliance complaints (two other claims-related issues fall in the top 10).
Test Mr. Hubbard's methodology using a simple table. List in column A three variables - chance of success, impact if the Project is approved, and impact if the Project is rejected. Make columns B and C variables for Project success and Project failure. Enter your estimates for these six values. (For examples, contact us: email@example.com)
Predictive analytics Project A success would likely impact medical expenses by eliminating some percentage of fraud cases and reducing some percentage of medical expenses for a smaller percentage of overall cases. You would estimate cases averted and costs avoided for a subset of total cases. In contrast, e-Billing Project B success would have a small impact on per-case costs but would impact 100% of total cases (administrative savings on every bill processed); and Project B should have some positive impact on direct program costs as well.
We believe this measurement approach will be eye-opening. At the very least the analysis requires us to be specific about defining the costs of retaining manual bill processing and the opportunity costs of competing information technology projects.
The usual culprits for not pursuing e-Billing Project B are software functionality (inability to attach medical reports) and insurer legacy enterprise software integration challenges. But technology advances by medical billing software and claims clearinghouses provide more integration options than existed a couple of years ago.
Assess the value of end-to-end electronic medical billing for your company. We have, and the business case for prioritizing project investments in electronic billing for workers' compensation and auto personal injury claims transactions is compelling.
Subsequent issues of iHCFA e-Billing news will highlight ways insurers and providers have solved implementation challenges with e-Billing cost effectively.