Claims data is a treasure chest full of vital information that revenue cycle management companies can tap into, to get better insights into their clients, their businesses, and general healthcare trends. There are many challenges that such companies face in accessing the data and using it for analysis and research. This blog will take you through these major challenges and the solutions to better access claims data.
Claims data is also called administrative data and this is an overall database of healthcare metrics in the country. It will give you a plethora of information, including people’s healthcare journey, metrics like age, gender, initial health problems, diagnosis, the treatment offered, the final bill generated, the cost of illness, and more.
Since the claims data is made up of actual notes given by the doctor too, it is used plenty by healthcare researchers. For revenue cycle management companies, this data can be used to better the services offered, understand denial and rejection trends, and improve the quality of service offered to clients.
Here is another reason why the claims data can be an invaluable information pool to healthcare RCM service providers. In many cases, there are pre-set guaranteed minimums and discounts and deals that insurance payers have with in-network providers. These agreements are designed to benefit both the healthcare provider and the payer.
Using claims data, the service provider can actually find out if the agreement is working for them or not. For instance, they can spot trends where the practice n is losing money due to these deals. They can also analyze if the patients are accessing advantage networks. Using the claims database, they will be able to design a better agreement with the payer, to ensure their profits don’t drop down. Revenue cycle management companies that work for these healthcare providers can create a more effective RCM system that tightens these agreements and deals and makes them more profitable.
One of the primary challenges in tapping into the claims data is inconsistency in the same. There are still a lot of manual processes and paper-based records followed that revenue cycle management companies may not be able to get the entire picture with the pockets of information they manage to collect.
The need to look extensively for data
In many cases, different payers may offer their claims data in different ways. One payer may have an online portal for providers to download information from while another payment may want the provider to send in a manual request to get the data. Even with data available digitally, the provider will have to log in to different portals and get this information individually.
Lack of time
Imagine a revenue cycle management company that is already working 24X7, handling claims. When they are barely able to meet deadlines, it will not be possible for them to work extra in collecting claims data and analyzing them. As a result, they wouldn’t do this, even if they know that the analysis is going to help them save money and improve the quality of service offered.
The solution proposed by experts from revenue cycle management companies and the healthcare industry is simple – working towards creating an electronic claims payment system. An electronic claims payment system will work on integrating claims data from multiple payers onto a single, easily accessible portal. The portal will safeguard sensitive information but will make it very easy for providers to access claims data easily. By digitizing the whole process, paper trails will be reduced and everything will be captured for eternity.
As of now, due to all the challenges in accessing claims data and getting a complete picture of patient financial responsibility, a lot of healthcare organizations are ignoring smaller, trivial claims and going only after the bigger ones. As a result, there is a lot of money voluntarily given up.
When providers start using a common electronics claims payment portal for all their payers, the claims data automatically is streamlined and available in the same place. This is advantageous in another way. When providers are offered information effortlessly, they get a better idea of what they are owed and end up generating correct bills. As a result, lesser claims are rejected/denied and the AR cycle shortens too. All these are smaller advantages that improve the efficiency of revenue cycle management companies over time.
Here are some of the other advantages of electronic claims submission.
Claims data is undoubtedly one of the most important information pools that can help healthcare providers offer the right treatments, identify health statuses, and create relationships between symptoms and health conditions. The claims data will talk in-depth about the medical and financial history of a patient and help medical practitioners and revenue cycle management companies better their services offered.
If you have been struggling to improve the existing RCM cycle for your healthcare client then analyzing the claims data could tell you what is going wrong. Working on an electronic claims payment system is the first step to getting valid and complete information that you can use for analysis.