Articles
The Case For Automated EOB Processing
May 18, 2006
•White Paper: The Case For Automated EOB Processing
The pressure for healthcare providers to offer quality healthcare in a cost-effective manner requires continuous and immediate access to sophisticated diagnostic information, updated patient records, and state-of-the-art data on drugs and medical procedures. There are countless patient records, insurance forms, laboratory reports, billing statements, payments, x-rays, charts, graphs, and nurses' reports that must be tracked and recorded. Every patient, case, prescription, operation, autopsy - every conceivable type of medical encounter - generates mountains of data, both electronic and paper, which must be audited, tracked, guarded, monitored, updated, filed, and eventually destroyed. Every case also entails submitting a medical claim or filing a report or form of some kind.
Throughout these procedures, healthcare establishments must concurrently comply with the strict requirements of regulatory legislation such as the Healthcare Insurance Portability and Accountability Act (HIPAA) and Medicare Conditions of Participation (MCP), plus government mandates for the implementation of electronic health records. At the same time that healthcare providers risk being overwhelmed by rising costs, they must deal with the growing demand to process more patient accounts with fewer resources.
Cost containment creates costly errors
While insurance companies are constantly pressuring healthcare providers to maintain strict guidelines, it is
the data, claims and remittance processing systems that aid rapid information throughput - and therefore
enable tighter controls over cost accounting procedures – that become the most critical links in the
relationship between provider and payer. Cost containment and wellness relate strongly to the issue of
efficient forms processing because the speed of data capture can also bear directly upon a provider's ability
to be responsive to patient needs. Failure to contain costs reduces shareholder value, but failure to deliver a
satisfactory level of care can cost even more in the courtroom. According to one industry study, 86% of
mistakes made in the healthcare industry are administrative in nature.
Managing a mountain of paperwork
Healthcare - perhaps more so than any other industry - is drowning in paper. Moreover, the cost of
processing the daily mountain of paper is staggering: experts report that the United States spends more than
a thousand dollars per capita per year - or close to four hundred billion dollars annually - on healthcarerelated
paperwork and the administrative procedures required to process over 48 billion healthcare
transactions every year. This astonishing number includes the expense of processing over 75 million pages
of medical claims per day nationwide, at a cost per day that exceeds $125 million - and every one of these
medical claims is potentially the basis of an Explanation of Benefits (EOB) statement.
The EOB form, because of its random, semi-structured appearance, has proven especially difficult to process – even more so than the tough-to-OCR medical claim form, the HCFA-1500. For years, the medical community has been saying that if it were ever developed and implemented, an EOB forms automation system could decrease claim denials, increase cash flow, and cut the medical records coding backlog –which would eventually translate into improved patient care. Recently, EMC Captiva applied its world-class medical claims processing expertise to solving the problem of extracting data from EOB forms. The result: InputAccel® for EOBs, a solution that slashes the costs of processing EOB forms and makes their administration infinitely more manageable.
Click Here To Download:•White Paper: The Case For Automated EOB Processing
