Healthcare organizations have a fundamental obligation to ensure that patients get the best possible care. No matter what type of treatment they deliver, healthcare providers must also ensure that they operate efficiently – whether in a not-for-profit or for-profit setting. One of the best ways to meet both of these objectives is to file claims rapidly and accurately at the same protecting patient privacy. It can be a complicated and challenging process, but today, providers are using technology to improve the effectiveness of patient care through online access to consolidated patient history. Today’s technology enables a reduction in the complexity and streamline the capture, warehousing and transmission of patient data across multiple, interconnected healthcare organizations. This enables providers to deliver the best care possible knowing the patient’s provider interactions across walk-in clinics, specialists and the emergency room.
At the same time availability of this data during the claims processing process ensure greater accuracy in benefit determination and faster pay-outs.
One of the primary challenges healthcare providers face when handling claims is a lack of access to patients’ health history. Patients interact with multiple providers across the care continuum, including primary care physicians, specialists, emergency rooms and walk-in clinics. To maximize revenue, healthcare organizations must provide payers with complete information when they file initial claims, but they may not have access to all the data they need.
To address that problem and get a more complete picture of their patients’ healthcare history for treatment needs, more providers than ever are moving from paper-based records to electronic medical records (EMRs). But even with EMRs, providers must still ensure that all data, centralized and accessible as patient history is sent to claims processers. One way to ensure the availability of this data is to implement a solution that monitors in real-time the applications that transmit EMRs as well as claim processing activities on the insurer side. Since providers and payers use applications developed by a variety of vendors – applications that are not necessarily interoperable or designed with claims processing enrichment in mind – this can be a challenge.
The ideal approach to facilitate efficient management of electronic records and revenue cycles is a message and transaction-monitoring strategy that accommodates increasingly high volumes of electronic patient information. To fully benefit from this solution, healthcare organizations must design processes that help them ensure compliance with HIPAA regulations by keeping patient data secure during transmission and cutting the mean-time-to-know: the amount of time required to identify problems that might affect the applications involved in data transactions. An effective transaction-monitoring strategy must provide:
- Real-time monitoring of all middleware and applications that stream patient data
- The capacity to accommodate high volumes of data
- Real-time analytics capabilities to detect potential problems before there is impact and to avoid false alarms
This approach can enable healthcare organizations to analyze an extremely high volume of data – millions of messages per second – to gather all the information that is transmitted between various healthcare systems. By doing so, healthcare organizations can spot trends and identify unusual charges, which can allow them to address potential problems with compliance or care delivery proactively. An ideal performance management solution of this type enables healthcare organization IT teams to warn users about potential problems before they require costly manual intervention in order to secure payment.
A healthcare organization’s first obligation is to provide quality care to patients. Healthcare providers also must find a way to efficiently track and manage care and secure timely reimbursement. New technology solutions can help providers fulfill their obligations to patients and improve profitability and compliance by delivering data and monitoring tools that improve accountability across the care delivery and claims administration process.
Healthcare organizations are on the front lines when it comes to filing claims and ensuring compliance. With a solution in place that allows them to monitor message flows and transactions and apply the latest data, healthcare providers can make sure they provide the best possible care to their patients and file claims correctly the first time, avoid incurring the costs involved in researching denied claims and reduce administrative errors. A proactive strategy backed by the right technology solution can help healthcare organizations serve patients better while operating more efficiently.
Edited by
Cassandra Tucker
