How Healthcare Management Technology is Reshaping Health Insurance

Some of the biggest technological advances in healthcare, including health insurance, have to do with the implementation of electronic health records (EHRs). Different healthcare facilities use different vendors, so not all EHRs will look the same or have identical capabilities.

In general, though, an electronic health record contains not only a digital version of a patient’s chart, including results from outside providers, but also detailed health insurance and billing information. In addition, EHRs typically include numerous features to simplify health professionals’ jobs, including form builders, electronic charting, appointment schedulers and compliance tools.

One of the biggest hassles in health insurance is tracking down whether a patient’s health insurance is up to date. Healthcare management technology can automate this process, allowing you to simply submit a patient’s information and get a real-time eligibility status, along with the patient’s copays and deductibles. This can free up time for other job duties that you would otherwise spend on the phone or sending emails to get the latest information. Some systems even allow you to run batch checks, ensuring that everyone who has a scheduled appointment that day has valid insurance and that nothing has changed.

With so many different insurance companies and plans on the market, each carrying its own limitations and exclusions, even a small healthcare practice could find itself dealing with dozens of different sets of guidelines. The same procedure that is covered 100% by one person’s insurance plan might be covered at 70% after deductible for someone else, and not covered at all by a third person’s insurance.

An even more confusing fact is that each insurance plan has its own documentation requirements that must be met for claims to be paid. But keeping up with all this documentation can feel like a full-time job on its own.

Healthcare management technology can take care of these inconveniences for you. Medical billers can simply set up each new patient’s billing information in the system and choose whether to bill right away. Choose to add reminders on the bill about documents that are still needed or to wait on billing until all documentation requirements are met. If you need to bill for a group session, such as a smoking cessation class or a behavioral therapy group meeting, you can batch bill all attendees at once and the platform will direct each invoice to the proper payor.

One of the most common reasons for insurance claim denial is simple user error. Whether you accidentally input the wrong code or forgot to include a required piece of documentation, the claim may come back as denied. While it would be impossible to eliminate human error entirely, a robust platform can help reduce the impact of error by serving as a first-line check. If something that was entered seems unusual or if the submitted documentation doesn’t meet the designated parameters for the specified insurance plan, you will get a warning. This allows you to go back and double-check your work before submitting the claim.

If a claim is denied, healthcare management technology can help you understand why. You can bring up the denied claim and a similar approved claim and compare them side by side. You can also review the details of the denial while going line by line through the submitted claim.

The manual insurance process is tedious at best. Keeping up with patients’ insurance information, checking eligibility, documenting appointments and submitting and tracking claims could involve multiple systems and a great deal of time on the phone. But many healthcare management technology solutions automate some of the back-end work, streamlining and speeding up these individual processes. This can result in quicker claim processing times, while also freeing you up to focus on other aspects of your work.

Providers are required to follow quite a few government healthcare regulations regarding documentation and record keeping, including as it relates to insurance claims. A strong healthcare management platform can help keep your facility in compliance through streamlined data-keeping that is all accessible from a single place. It can also help to hold individual employees and the organization accountable through an elaborate system of reminders and automatic document forwarding.

Ultimately, not every insurance plan is going to be the right fit for your specific healthcare organization. Maybe a company doesn’t cover the procedure in which you specialize. Perhaps certain plans have a track record of frequent claim denials and slow payouts. In these cases, it might make sense to stop accepting specific plans or even sever ties with an insurance company altogether.

But how can you know if you’re making the right decisions if you don’t have data to prove your theories? A huge advantage of today’s healthcare management technology can be its ability to capture data from each transaction and then present it to you in a variety of reports. Depending on the specific platform you choose, you may be able to track all your claims from a single insurer or even compare the track records of different insurance companies to each other.

Healthcare insurance is a complex topic, with so many different insurers and plans on the market. But healthcare technology solutions can help streamline the claims process, reduce user error and boost compliance, all while giving you the data you need to make informed decisions about which insurers and plans to accept.