As healthcare organizations continue to struggle with staffing shortages and rising costs, they search for ways to alleviate the burden of manual and repetitive tasks on their existing staff. Over the past two decades, so many aspects of healthcare data have been digitized, yet many of the manual processes across healthcare have not been replaced by more tech-forward and less human-touch processes – therefore losing much of the potential from digitization. This is particularly true in the necessary and lawful movement of data across organizations in service to the continuity of patient care, ongoing healthcare operations, and third party legal and insurance requests. Perhaps unsurprisingly, the area of record exchange has made the most progress as it relates to the payment of care and the rise of clearinghouses to automate and optimize the exchange of information. When done securely and responsibly, this liquidity of healthcare data presents massive opportunities to reduce manual labor in healthcare.
In healthcare, clearinghouses typically serve as a go-between for providers and payers, translating data into a format that a payer can use and checking for errors or inaccuracies before forwarding claims to the correct payer. Since the revenue cycle in healthcare is anything but simple, this is vital for reducing repetitive manual labor for office staff. Complicated treatments, co-morbidities, and insurance coverage are a few aspects that need to be considered during the billing process. Without a clearinghouse, staff are responsible for scrubbing claims for errors, verifying patient eligibility, ensuring medical coding is correct for the patient situation and the care delivered, and routing the claim to the correct payer.
With financial clearinghouses, bills can automatically route to the correct payer and pull patient information, as needed, thus reducing the need for back-and-forth communication between provider and payer. By making the exchange of information between providers and payers more efficient, the use of clearinghouses typically results in decreased workload for the provider and the payer, faster processing of claims and payment to the providers, and the opportunity for the provider to focus more time and attention on their core competency: delivering patient care.
Clearinghouses are just one great example of how the enhanced exchange of healthcare data can increase efficiency for healthcare providers and the greater healthcare community. Other opportunities to rethink data exchange processes given the digitization of healthcare data include:
Automating the fulfillment of third-party and legal record requests – Providers receive hundreds of millions of third-party record requests each year in service of a legal proceeding, an insurance claim, life insurance applications, etc. While healthcare providers have an obligation to fulfill these requests, the work effort involved is substantial taking staff’s time and resources away from the delivery of care. Given the rising cost of care and erosion of margins for healthcare delivery organizations, there should be an urgency to increase the efficiency of non-care related activities.
Biotech and pharmaceutical needs – Companies and organizations that investigate the cause, diagnosis, therapies/treatment and cure of disease have a need to use real-world data. Historically it has been difficult for healthcare delivery organizations to provide the necessary data because the processes were manual and burdensome. By easing that burden through automation higher fidelity data can be delivered faster, shortening the research and innovation life cycle for these companies and organizations, ultimately improving care and enhancing or even saving lives.
For some healthcare delivery organizations, the concept of using clearinghouses and other forms of automated data exchange can be intimidating. After all, anytime a process is digitized, you are inherently giving up a level of human control. It’s vital to choose a partner that is aligned with your security standards, cost expectations, and helps you bridge the gap between pre- and post-digital workflows. If organizations work with clearinghouses and data exchange platforms that they trust, the opportunities for improvement in administrative healthcare work are endless.
Financial clearinghouses are powerful data exchanges inside of which intelligence and functionality can be built that reduce the time and effort to receive reimbursement for the care delivered. By expanding the concept of financial clearinghouses to other areas like third-party record requests and life sciences companies and organizations, healthcare providers have the opportunity to spend more of their time and resources on patient care, and less time on manual, administrative tasks.
Photo: chanut iamnoy, Getty Images
As the Chief Digital Distribution Officer of Ontellus and President of ChartSwap, Nate Kelly is responsible for the overall growth in digital record exchange connections. Nate has spent more than 20 years leading healthcare IT organizations, formerly the Chief Commercial Officer of Hospital IQ and VP & GM of Health Networks at Cerner Corporation. Nate’s passion is increasing the efficiency of processes throughout the healthcare ecosystem by leveraging big data concepts and advanced analytics.
Nate earned a BS in Kinesiology from the University of Minnesota, an MBA from the University of Missouri, a Certificate in Healthcare Leadership from the University of Missouri-Kansas City and a fellowship in the American College of Healthcare Executives (FACHE). Nate serves the community as an advisory board member for two University of Missouri graduate programs and as a board member for Adoption & Beyond, a not-for-profit adoption agency serving Missouri and Kansas.
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