Providers interested in automating claims process to gain ROI

Healthcare providers are interested in automating their workflow, but only if there is a demonstrated return on investment, according to a recent study from consulting firm IVANS.

In its report "2012 Healthcare Provider Survey: Key Findings on Revenue Cycle Management, Audits, and Automation," IVANS found that providers would like to submit more healthcare information electronically, but healthcare IT needs to be offered in a cost effective manner and guidance in its implementation is critical for widespread adoption to occur.

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Readily available solutions, such as automation software and web-based portals, can significantly improve revenue cycle management, but these technologies must demonstrate a high degree of usability and affordability among providers to be successful, noted the survey. Further, these solutions must empower providers so they have more visibility and control over their cash flow.

Other study findings include:

• 93 percent of respondents believe Medicare is fair either all or most of the time with claims reimbursements. however 62 percent do not believe commercial payers are fair all or most of the time, with 49 percent stating they are fair only some of the time when reimbursing claims.
• 39 percent of providers still use paper to submit claims to commercial payers, but less than one percent use paper for Medicare claims and only 11 percent still use paper for Medicaid claims.
• 65 percent of healthcare respondents said Medicare was the fastest payer, 26 percent said Medicaid and only nine percent said commercial payers were the fastest.

"When you look at Medicare and Medicaid, they offer free software (and training) as far as how to submit the claims and it seems to be a little more standardized," said Michael Schramm, president of IVANS' healthcare services, explaining why more providers use an automated process for Medicare and Medicaid claims than for commercial payer claims.

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"Some of the providers are smaller that do use the free software to submit claims to Medicare, and they still are very paper driven," added Schramm. "If they can use free tools that are provided through Medicare that helps them automate the process as much as possible. On the commercial side, they don't have the robust system that can handle all of this so they revert to just submitting through paper."

The question of why providers view the government programs as fairer than commercial insurers is a little tougher to answer, said Schramm.

"Providers may have to be managing multiple rules for commercial payers," he said. "There could be some discrepancies on the rules."

"We were a little surprised by some of this information, as well, which is why we are digging into it," added Schramm, noting that IVANS will be conducting more research to discover "what is driving some of the responses."

Providers who automate their claims system generally find a positive return on investment, if they train their staffs correctly and budget for any reduction in productivity that might occur at the beginning, said Schramm.

"Automation does seem to pay off," he said. "You have to be able to do the investment in technology and you have to put in the time to do the training, to educate the people doing the processing on a daily basis. There is an investment, either in a direct cash outlay or in retraining human resources."