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Thom Ransom

Thom Ransom

Thom is Digital Marketing Manager overseeing search marketing for ImagineSoftware. He has spent eight years managing campaigns in healthcare and financial services, and consultants with Charlotte small businesses on ways to attract more customers online.

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A Beginner’s Guide to Electronic Claims Processing

Innovations like electronic claims and electronic healthcare records are the start of a revolution in healthcare; one that promises to dramatically simplify the way billing offices, practices and hospitals get paid. In this article, we will cover a brief definition of electronic claims, why they are important to the medical billing industry, and ways you can adopt this new technology for the betterment of your patients and your practice.

Reduce the length of your medical billing cycle by 30-days between charge post-date to first payment through electronic healthcare claims processing.

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Electronic Claim Definition

What is an electronic claim? An electronic claim is a form generated electronically for communicating a patient’s demographic information, insurance and treatment between the payer (or clearinghouse) and healthcare provider. Electronic claims essentially eliminate the need for paper records and are quicker this manually submitting a patient’s information.

Adoption of electronic claims began in 1975 when the National Uniform Billing Committee (NUBC) began developing a standard data set used nationally by healthcare institutions, providers, and payers. These standards took into considered the need for information against the burden of providing that information and culminated in the adoption of the national uniform bill, or UB-82, seven years later. These standards established one nationally accepted health billing form. Smaller committees were formed on a state level to implement the UB-82 manuals.

Paper Claims vs. Electronic Claims

A lot of time and money can be saved by not having to print out forms, complete them manually, and sending them via snail mail to health insurance companies or payers. Through electronic claims and the absence of manual labor, the human error quote goes down. Old paper claims were hand written and illegible. Claims sent electronically receive an error rate between 2-3 percent, while claims submitted on paper have an error rate of around 28%.

Software systems are also not without its flaws. Especially, if there is a glitch in the system or the internet is down, it may be difficult to access certain data which would not be the case with manually filed claims. All in all, this is not supposed to happen and is very unlikely to last longer than a fraction of a day which makes electronic claims still advantageous over manually claimed files. Paper files on the other hand must be stored safely for a very long time and can be destroyed without the chance of getting them back which is very unlikely to happen when submitted claim files electronically.

Automated Electronic Claims Submission

Automated electronic claims submission integrates your electronic claims to your existing workflow. First, paper claims are converted electronically through optical character recognition imaging (OCR). Next, your medical billing software aggregates and scrubs each claim for potential denial triggers that could delay the cycle. Third, the clearinghouse sends the claims electronically to the insurance carrier through a secure, HIPAA compliant connection for real-time visibility into the status of the claim. Last, the claim is accepted, and your organization receives reimbursement. An integrated business intelligence tool like ImagineIntelligenceTM can be used to compile a report of the most common causes of claim denials to mitigate potential loss in productivity later.

Other Advantages of Electronic Claims

What are the benefits of submitting claims electronically? Electronic claims can be stored on a data server and submitted one of two ways: either directly to the payer through direct data entry, or through a clearinghouse. Both methods are more accessible and less fragmented than paper claims when shared among specialists. Billing offices, practices and hospitals typically see a reduction in processing time with electronic claim submission clearinghouses between confirmation that the electronic claim was received and real time status checks on when the claim has been approved. Likewise, there is less of a chance of claim files being lost on the way to the healthcare provider when compared to paper claims.

With electronically submitted claims, hospitals, primary care providers and other physician offices can gain efficiencies through more automation and less staff work. Considering providers spend anywhere between 10 to 30 minutes per claim on manual tasks, the potential savings is huge when considering the savings on paper, postage, ink, staff, and envelopes. Health insurance companies can also process electronic claims faster and with less effort.

Electronic Medical Billing

Earlier this year we wrote a blog article on the benefits of eliminating paper from your revenue cycle through electronic medical billing. In the article, we mention medical providers could save at least $1.1 million labor hours per week by transitioning to full electronic claims processing. Electronic medical billing is easy to use and helps practitioners reduce the time spent filling out forms. When integrated with electronic patient collections, practice owners can reduce overhead while generating additional revenue through more efficient revenue cycle management.

The healthcare industry is moving swiftly in the direction of digitizing the entire revenue cycle. In 2017, just over 6 percent of healthcare claims were submitted as paper forms. Financial organizations big and small have a lot to gain through integrating electronic claims processing with other parts of the revenue cycle. Schedule a live demo today to find out how the Imagine Team can work with you to integrate electronic claims processing into your existing workflow.


Using Patient Billing Software to Drive Better Patient/Provider Connection

For those that follow healthcare closely, there isn’t a week that goes by that the conversation around the shift in patient responsibility doesn’t come up and with good reason. In 2018 the average deductible was north of $1,500 and growing.

Imagine a future in which consumers are empowered with more options for managing their healthcare costs.

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Generally, when you hear these stats they are all focused on one conclusion: Patients are responsible for more of the bill than ever before and providers are spending too much time trying to collect those payments. Recently Fierce Healthcare published an article quantifying this challenge. The article painted a grim picture of the challenges independent medical practices are facing:

  • 70% of respondents are worried about administrative tasks taking time away from patients.
  • 63% of respondents are worried about patient responsibility.

It’s important that we don’t downplay these challenges. They are real. However, for all the challenges this presents, equally as large is the opportunity providers have in capitalizing on the trend and building a competitive advantage in the marketplace.

The Patient's Perspective:

Healthcare is one of the most complex transactions in the economy. It comes with a range of emotions that aren’t present in any other transaction. Not only are patients possibly given a diagnosis or prognosis that is unwelcomed, but they may also be given a price that they simply can’t afford. The out-of-pocket shift has made going to the doctor a complex choice and in many cases patients are putting off or simply declining the coverage they need.

The Provider's Perspective:

At the end of the day, a healthcare practice is still a business. Now more than ever the financial viability of a healthcare practice is tied to their ability to be effective and efficient in capturing from the patients. However, efficiency and effectiveness need to be evenly matched with compassion and professionalism. Billing professionals are tasked with asking patients to pay for a diagnosis they didn’t want, it’s extremely difficult to do.

Best Practices for Patient Billing:

A fundamental consumer expectation in any financial transaction is being able to answer one simple question- how much will this cost? Unfortunately for the consumer, many hospitals and health care systems lack the ability to do so. Similarly, the healthcare industry is far behind others when it comes to offering the kinds of services that consumers expect, like online appointments and automated payments. Patient are confused and scared by the billing process. The first and last point of contact patients have with your practice is with billing. With that in mind, below are a few recommendations for ways to bridge the gap between patients and provider:

  • Communication- One of the biggest challenges facing patients today is they simply don’t understand their bill. Providing clear, up-front messaging about anticipated/estimated balances and following up with patients about their bill alleviates this concern and comforts the patient. Engage patients when and how they want to communicate.
  • Technology- There have been rapid advances in the technology available to aid in the collections process. Tools like integrated patient pay services (time-of-service or online) have made the posting process seamless for both the patient and provider. Advances in data collection and analytics have brought artificial intelligence to the forefront allow doctors to more accurately identify problem areas and periodize them.
  • Payment Options- With healthcare bills ranging from a few dollars to several thousands of dollars, patients need multiple options to pay their bill. An omnichannel approach combining all payment modalities (in-person, online, over the phone, etc.) ensures you have the right tools for all patients. The goal is to provide a pathway for the patient to pay on time or over time.

Getting paid for healthcare services is hard. It is hard on the patient financially and hard on the healthcare organizations resources. However, when you recognize that this challenge is also an opportunity to provide the patient with the payment option that suits them the best, the result can be happier patients and staff members alike.


5 Best Practices for Healthcare Revenue Cycle Management

Some businesses don’t realize how much cash flow is available in their balance sheets. It’s important for providers to periodically review their organization’s revenue cycle for any inefficiencies or improvements that may be holding the company back from growing. You can eliminate manual data entry errors and reduce transaction times by automating processes. However simply cutting costs is not enough to build a successful practice. Creating a positive patient experience is also crucial for the long term financial success of any practice. Below is a brief overview of medical revenue cycle management along with some best practices for improving revenue cycle management in healthcare.

Billing offices and practices can save an average of $3.60 per eligibility check and benefits verification by switching to an automated system.

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What is Revenue Cycle Management in Healthcare?

It’s difficult to define healthcare revenue cycle. There’s a lot of overlap between the revenue cycle management process, practice management, and medical billing; all of which involve managing the relationship between patient, payer and provider. Depending on your specialty or practice, the definition of healthcare revenue cycle management consists of systems and procedures built to reimburse doctors for time and resources spent on patient requests. The typical healthcare revenue cycle flowchart consists of the following steps:

  • Clinical Operations- RIS, LIS, EHR/EMR, or any system used to manage the schedule, registration and demographic information of patients
  • Medical Coding- translating procedures into CPT, ICD and HCPCS codes. Claim scrubbing, data validation, and submission
  • Payer Contracting- reconciliation and remittance with the insurance company, payer or clearinghouse
  • Patient Billing- payment posting, statements, billing methods, and collections
  • Reporting- data mining, forecasting and practice analytics using financial and performance data

Best Practices for Improving Healthcare Revenue Cycle Management

Despite the challenges associated with revenue cycle automation, it’s important for billing offices, practices and hospitals to adopt smart and flexible billing methods. If done thoughtfully and utilizing the right technology partner, the benefits will quickly outweigh the cost of training and implementation.
  1. Build charge capture and verification into the revenue cycle. On average, hospitals lose around 1 percent of their potential net revenue due to missed charges and loss of productivity. Electronic claims processing takes 30 percent less time compared to manual processing. Today, charge capture and file transfers can be performed using automated timers and natural language processing with little to no manual intervention.

  2. Automate and collect patient financial responsibility upfront. The more information you can provide up front to help patients understand and manage costs, the fewer write-offs you’ll have to manage in the end. Administrative costs can increase if organizations use manual processes to check prior authorizations and eligibility. CAQH’s 2016 Index showed manual prior authorization can cost providers an average of $7.50 per transaction, while electronic prior authorization can cost as low as $1.89 per transaction.

  3. Streamline your office’s front-end and back-end responsibilities. There's a large grey area between clinical modalities and revenue cycle operations. It is in this space where payments get lost in translation. This disconnect between front-end and back office systems and the resulting manual data entry is an invitation for errors. Electronic eligibility (or e-eligibility) along with fully integrated clearinghouse promotes more transparency into the status of a claim while minimizing denials.

  4. Use data to benchmark and forecast medical revenue cycle performance. Keep your finger of the pulse of your practice’s financial health AND staff performance. Each step in the revenue cycle should have its own set of KPIs. Setting KPIs and tracking over time will unveil bright spots in your revenue cycle and show you how to manage resources better.

  5. Treat billing and payment as one unified system. Today's technologies provide a tremendous opportunity to merge billing and payment into a single, cost-saving process. Since many customers already perceive billing and payment as one thing, the technology should be set up to reinforce that. When connected, billing managers can recognize patient payments faster, while a paperless billing process can deliver a better patient experience.

Sometimes realizing additional revenue takes more than new processes. So where to begin? Start by identifying two or three inefficiencies or challenges preventing your company from growing, either through a loss in revenue or patient satisfaction. Then identify opportunities and technologies that can improve operational efficiency as well as the ability for patients to understand and pay their bill. Consider the above revenue cycle management healthcare best practices and you will be well on your way to building a stronger business case for improving your revenue cycle performance.


Risks in Healthcare Cybersecurity and How to Avoid Them

Healthcare Cybersecurity Statistics 2019

  • This year, there have been 3.68 million individuals affected by data breaches currently under investigation by the U.S. Department of Health and Human Services.
  • Healthcare data breaches are reported at a rate of one per day.
  • Security company Cybersecurity Ventures predicts that healthcare will incur two to three-times more cyber-attacks than the average of all other industries.
  • The most common locations of breaches to patient health information (PHI) are email, printed documents, and a company’s network server.
  • Hacking and IT-related incidents account for most data breaches. Other causes include misuse of administrative privilege, improper disposal, theft and unauthorized access.
The average cyberattack for a small healthcare provider can cost upwards of $1 million in recovery. Download white paper, "Healthcare, Cybersecurity, and You."
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What is Data Privacy in Healthcare?

The most widely agreed upon standard for data privacy in healthcare comes from the HIPAA Privacy Rule which establishes national standards to protect patient medical records and health information.  The rule requires appropriate safeguards for ensuring the privacy and security of PHI including who is covered by the privacy rule, the type of information that’s protected, and limitations in how PHI can be used by a company or practice.

Sensitive healthcare data can include patient data like PHI, payment records, payer and provider employee data, and data related to wired and wireless IoT (Internet of Things) medical devices.  47 states have laws that require security breaches involving personal data to be reported to the authorities in addition to HIPAA’s Privacy Rule.

Importance of Data Security in Healthcare

Why is information security important in healthcare? For starters, it’s a market opportunity, and it’s a goldmine for criminals!  Cyber criminals cost the global economy over $400 billion a year, according to estimates by the Center for Strategic and International Studies.  As we saw with Target in 2013, just one data breach can throw a $145 million wrench in the cogs.  Healthcare data breach costs are the highest of any industry at $408 per record.  While credit card information and PII sell for a couple dollars on the dark web, patient health information can sell for as much as $363 according to the Infosec Institute.

Types of Healthcare Data Security Threats

One of the best preventative measures you can take to secure your company’s data is to educate yourself on the methods used by hackers to access PHI.  Most threats are a combination of software and social engineering.

  • Ransomware – Ransomware is a type of malicious software where an attacker holds a user’s system or personal information hostage in exchange for payment.  The healthcare industry accounted for 88% of all ransomware attacks in the U.S. in 2016.
  • DOS Attacks – DOS or denial-of-service attacks are a type of attack where your server is bombarded with traffic requests to overwhelm and shut the service down.  Like Ransomware attacks, DOS is often used to hold a web-based service hostage.
  • Phishing – A phishing scam tricks users into unknowingly providing access to a system through an email or pop up disguised as a legitimate request.  According to a 2018 report by phishing defense company Cofense, terms most often used in email subject line for phishing attacks include “New Message in Mailbox” and “Attached Invoice.”
  • Man-in-the-middle Attacks – This is a type of cybersecurity attack where an attacker eavesdrops on communication between two entities.  Man-in-the-middle attacks can occur through your SSL, Wi-Fi network, and DNS.
  • Malware – A malicious software like a virus, worm or Trojan horse where code is injected into your computer to steal, delete or encrypt information.

Healthcare Data Security Challenges

Annual data breaches have increased by 73% between 2010 and 2017.  34% of healthcare data breaches occur from unauthorized access or disclosure.  While seemingly more threatening, malicious breaches occur half as often as breaches due to internal mistakes.

According to the FBI, an increase in healthcare cyber intrusions is likely due to a lack of resilience compared to the financial and retail industries.  Health organizations have a lot of information that’s valuable to criminals.  They often have a bunch of personal information that can be used for traditional financial fraud, as well as health insurance information that can be sold for even more on black markets.

Most healthcare breaches are motivated by financial gain, with healthcare workers most often using patient data to commit tax or credit fraud.

The unfortunate truth is that the healthcare sector is an easy target for cyber criminals because of its vast ecosystem.  There are so many interconnected individuals that have access to medical and billing records – patients, dependents, specialists, physicians, hospitals, billing service providers, health insurers… the list goes on and on.  Not to mention medical records are the highest valued credentials on the dark web at $20-$50 per record – that’s at least 90% higher than the value of someone’s credit card information.

According to a recent study by the Information Systems Security Association (ISSA) and Enterprise Strategy Group (ESG), the top cause of risk to cybersecurity in healthcare include a lack of training, lack of enforcement, and overconfidence.

Tips for Cybersecurity in Healthcare

Healthcare data security is by no means "one size fits all."  A small, rural practice will invest differently than a large, metropolitan hospital.  Based on your business and your needs, you should identify what data is most important to protect, then plan your safety measures accordingly.  Perhaps you'll realize that technology isn't what's needed, but people and processes instead.
  1. Promoting safety standards isn't just IT's job.  Appoint a security officer within each department to help promote good practices, you’ll have more eyes and ears dedicated to the cause and spread awareness on a more granular level.
  2. Use firewall and anti-virus to protect against malicious intrusions.  The firewall inspects all messages coming in from the outside and decides whether the message should be allowed in based on pre-determined criteria.  Anti-virus stops malicious software that has already surpassed your safety measures and entered the system.
  3. Passwords are your first line of defense when preventing backs into any server.  By ensuring that employees have a strong password, a company can all but eliminate 75-80% of cyber-attacks.
  4. If a hack or breach does occur, disclose the incident immediately to your security team.  Information can often be recovered if authorities are notified soon after a security breach.  Recovering data is extremely difficult as more time goes by because of the network of offshore channels this information is relayed through.

Your company may have the most intuitive healthcare cybersecurity software and direct safety processes. But at the end of the day, your safety culture won’t shift until every single employee consciously decides to change their habits.  It requires leadership and commitment!

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