Examples of these new capabilities, illustrated by the Stone Clinic, include:
- Rejected claims analysis: The practice can view rejected claims over time and by health plan, making any needed adjustments to improve performance.
- Status by plan: Physicians and other healthcare providers can determine the relative importance of each payer to the practice, which is important information for practice management and contract negotiations.
- Transparency and partnership: With providers and payers working from a common claims database that each can review in real-time, transparency, and partnership opportunities are increased.
- Cash flow: Access to cumulative claims information enables providers to better understand cash flow and plan accordingly.
- Illustration: Using graphics software, practices can track, trend and illustrate their claims experience over time. Full color charts are often the most effective means of identifying trends and communicating with physicians and staff.
- Treatment plans: Not only can a practice view current claims status, it can also anticipate payments in the future for patients requiring multiple visits. Treatment plans can be adjusted based on projected future adjudication experience.
- Analysis opportunities: With a centralized database, the possibilities for analysis are expansive. Practice managers can interrogate the payer claims information database over time, including legacy systems, to track and trend by payer, physician, and diagnosis. The astute practice manager uses this information to enhance patient quality as well as ROI for doctors.
Healthcare providers are increasing their reliance on automated solutions and seamless connections to payers to assure smooth flows of patients each day. These practices also need the ability to track and trend financial claims data so they can do a better job with daily management and strategic planning.
The latest information technology tools from transaction integrators are opening up new ways to use financial information strategically. Data mining, dashboard reporting, and customized analytics make detailed, historical information readily available and in meaningful formats. The result is more successful practices that are better able to provide quality patient care in the rapidly changing healthcare environment.
Barry Byrd is president of Secure EDI, a healthcare information technology firm. He may be reached at email@example.com.
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