It’s Time to Automate Provider-Payor Transactions

This post excerpts an interview in the Q2 2016 Provider Advisor about our new automated enrollment solution, EchoOneEDI, powered by Madaket Health.

Subscribe to Provider Advisor.

CMS’S INCENTIVES for the meaningful use of electronic health records (EHRs) set into motion a plan to improve the quality of healthcare while improving efficiency and accuracy and reducing paperwork. Today, nearly all hospitals and three-quarters of physicians are using EHRs. Yet the upfront processes of enrolling physicians with various payers and automating billing functions have not changed significantly for over a decade. These tasks are still largely manual, requiring dedicated staff to stay on top of applications and manage ever-changing provider information. And the cost is high. According to a Health Affairs study, up to 10% of physicians’ operating income is devoted to billing and insurance functions.            

Most practices are still completing manual applications with each of their payers for common services, including eligibility verification, claims status inquiries, and electronic funds transfer. Despite the fact that all payers need essentially the same information, each one requires the data to be sent in a different format. Many of the largest payers in the U.S. still require providers to send information by mail or fax. Nevertheless, the automation of provider-payer billing functions is poised for significant growth. Healthcare organizations are increasingly challenged to do more with less and are motivated to take advantage of the efficiency and cost savings that can be achieved by using electronic billing functions. The analytics arm of the Healthcare Information and Management Systems Society (HIMSS) forecasts 200% growth for electronic data interchange (EDI) functions in 2016. Further, the Healthcare Administrative Technology Association (HATA) recently issued an industry call to action for 100% adoption of electronic funds transfer and electronic remittance advice. HATA is a strong supporter of administrative simplification and industry efforts to streamline the claims revenue cycle.

Making the Case for Switching to Electronic Billing Functions

The cost savings are impressive. Some industry experts report that practices can save an average of $7.21 per payment simply by switching from manual to automated remittance and payment processing. In addition to receiving funds on average seven days sooner than with paper checks, providers can save over $2,000 per year by using electronic funds transfer (NACHA). Providers can also save nearly $3.00 per transaction by switching to electronic eligibility verification. With an average of 1,250 verifications submitted per year, electronic eligibility verification can result in an average annual savings of $3,700 per provider. While the business case for using electronic billing functions is clear, the work involved to enroll in these cost-saving tools is hindering adoption. A typical healthcare provider works with 25 different payers. To take advantage of electronic billing services, providers must complete an application with each payer. Across different transaction types, that makes for countless forms to download, fill out, and manage through to completion.

April 1, 2021

Request Demo