Administrative Costs Bringing Health Care Down
Tuesday, 11. August 2009
There has been much discussed and written recently about how cost control is a necessary component of health care reform. CNN recently highlighted the six primary sources of wasteful health care spending, which amount to a whopping $500 billion. Claims processing made the list — and for good reason.
As a medical billing software company that also functions as an approved clearinghouse of medical claims, Nuesoft witnesses first hand the administrative costs and inefficiencies related to claims adjudication. There are an estimated 6 billion medical claims filed each year by medical practices and hospitals. If every single one of those claims could be filed according to the exact same data protocols, with no payer specific differences for required fields; imagine the time and money that could be saved. By simply adding uniformity, transparency and clarity to the exchange of data between providers and payers, and leveling the playing field for all involved, we can vastly impact the system, and help medical providers divert resources away from administration and back toward activities that support patient care.
Sherri Dumford Says:
I read with interest the items listed as the top $ wasters in our health care system and was not surprised that processing claims was in the top two. In fact, I’d probably argue it really is number one. I’m not certain of the metrics used to determine what constitutes “overtesting”, but I doubt unless we change our litigious culture that physicians will rest easy in reducing the number of tests. The delivery and management of more reliable and efficient patient care through the use of technology could avert unnecessary procedures and/or avoid mistakes.
Administrative simplification; however, is an area that could have a dramatic impact on healthcare expenditures. HIPAA and standardization was supposed to help achieve simplification and thus reduce costs. It should go without saying that allowing insurers to have companion guides requiring the “billing chain” to operate with standards in addition to the standards cost software companies, billing companies and ultimately the provider and patient. Requiring the use of standard denial and remark codes; eliminating the long wait time for provider enrollment and simplifying the appeals process are areas where significant improvement in the cost of providing and get paid for healthcare could be improved. Require the insurance industry to be compliant with the standards!!