Increased use of automation, but $16.3 billion savings potential still remains for healthcare industry
Automating common healthcare administrative transactions, such as prior authorization, has reduced annual costs by $122 billion, finds the 2020 CAQH Index. However, the industry is still leaving $16.3 billion in potential savings on the table.
CAQH is a non-profit alliance of health plans and trade associations focused on the business of healthcare. The eighth annual report tracks automation, spending, and savings opportunities for revenue cycle transactions relating to verifying patient insurance coverage and cost sharing; obtaining authorization for care; submitting claims and supplemental information; and sending and receiving payments. It categorizes these transactions by whether they are fully automated, partially electronic, or manual. Not only has automation increased since last year's report, but so has the opportunity for savings. The report estimates that the savings potential has risen by $3 billion annually, thanks in part to a drop in costs for automated processes.
In addition, the costs associated with some manual and partially electronic portal transactions are increasing.
Although prior authorization achieved the greatest year-over-year progress in moving toward automation, it's still conducted manually more often than any other transaction. Electronic adoption of prior authorization transactions rose eight percentage points, saving the industry $9.64 per transaction. The 2020 Index also highlights other areas that are rife with savings opportunities. For example:
Each fully automated claims-status inquiry costs $11.71 less than the same manual transaction and accounts for 17% of the total savings potential.
Each eligibility and benefit verification converted from manual to electronic saves the medical industry $8.64 and accounts for most of the total industry savings opportunity (51%).
Remittance advice accounts for 19% of savings opportunities.
The 2020 Index only includes data from health plans and providers through the 2019 calendar year and doesn't consider the impact of COVID-19. But CAQH says based on initial survey responses, they're seeing that the volume of administrative transactions changed significantly in 2020, in some cases decreasing by more than 20% compared to the same timeframe in 2019.
The Right Technology Partner
The right revenue cycle partner can help you automate these manual processes and enable your team to maximize your bottom line. Quadax’s products can automate and significantly reduce your team’s manual work when checking claim status, eligibility information and handling remittance documents.
Automating Claim Status
Advanced Claim Status (ACS) by Quadax automates costly, manual and unnecessary follow-up tasks related to the status of claims as they move through the adjudication process. Using client-defined business rules, the ACS engine will query a claim’s status by polling the payer’s web portal with advanced screen-scraping technology to ensure the most up-to-date and actionable payer responses. Based on the responses, claims that require immediate action can be routed to the responsible party to accelerate claim follow-up. Comment records are delivered back to the EHR and/or billing application sooner so staff can work smarter.
Confirming Insurance Eligibility
Quadax’s Insurance Eligibility solution confirms payer coverage and benefits information (including copays, coinsurance and deductibles) electronically to more than 800 payers, in real time or batch throughout the billing process — from scheduling, pre-registration, registration to discharge. The solution provides enhanced services surrounding the request, response and review of a patient’s insurance eligibility.
Automating Remittances
RemitMax by Quadax automates the processing of paper remittance and correspondence documents. Source documents (e.g., EOBs, patient payments, patient/payer correspondence, credit card settlement files, payroll deduction reports) and claim data (837 of electronic claims, 837 of UB and 1500s sent hardcopy) are automatically converted to ANSI 835s, information is verified using claim data and converted into electronic documents with detailed indexing. RemitMax then automatically stores this information in your billing system(s) and automates the necessary workflows for follow-up activities.
Technology is Nothing Without People
Quadax is a Best in KLAS Claims Management vendor. The Quadax Claims Management application enables providers to achieve greater control over their revenue cycle to streamline, automate, and customize their claims and follow-up workflow to meet their own unique needs. And, the Quadax first-pass acceptance rate of 99.6% helps clients to realize greater cash flow with less work!
The things technology cannot provide, however, remain critically important to healthcare revenue cycle leaders, and it’s in those areas Quadax shines even brighter. Our commitment to reliable, expert, personal support means every account has a dedicated account manager. A team of real people answer the phone when you have a question or concern. We personally work with every client to help them use our products in the best way to meet their distinct needs and goals.
Let’s take on the revenue cycle together! Learn more at Quadax.com/TheDifference.
