How advancing digital capabilities and automation in healthcare can improve insurance claims processing speed, account for variable document volumes, and mitigate one of the busiest times of the year – open enrollment.
The Current State of Document Processing in Healthcare
Healthcare is one of the most data-intensive industries out there. There were nearly one billion visits to healthcare providers in 2019, which generally involves patient intake documents with medical history information, authorization forms, immunization records, lab reports, bills, claims and more. What often follows after a visit is a frustrating and time-consuming process to ensure records are updated, requests are processed, and claims are received and paid out correctly and in a timely fashion. Inefficient, outdated technology and processes requiring manual data entry creates unnecessary costs, introduces risks, and prolongs turnaround times.
To add to the complexity, the documents that require processing are inconsistent. The documents can vary with mixes of handwritten text, numbers, or stamps depending on the nature of the request, and they can be received by mail, email, fax or scan.
Medical claims, in particular, are one of the largest causes of patient dissatisfaction with the healthcare system, which recently hit a 10-year low in customer satisfaction. Nearly one in five Americans is hit with surprise medical bills – oftentimes months after treatment – and has to scramble to submit the bill for payment processing.
When it comes to document processing within the healthcare industry, McKinsey estimates that today less than 10% of medical record reviews are automated. On the payer side specifically, the average medical claim takes 40 minutes and costs an average of $15 to process manually.
The same McKinsey report states that only 25% of pre-authorization work is automated, leaving the rest to manual data entry. Pre-authorizations, which is documentation doctors submit to justify their recommended treatment, are often required before many medications can be prescribed or services can be performed. It’s reported that 92% of prior-authorization issues contribute to care delays.
Adding stress to an already-burdened and heavily manual system, insurers also have to deal with the annual open enrollment period, which runs from October to December every year for coverage starting in January. During this time, individuals are allowed to start, stop or change their health insurance plan. There are currently 61 million individuals enrolled in Medicare programs, and of those, it’s reported that in 2019, 50 million did so via a paper-based, handwritten form. This is just one example of the large influx of forms firms receive in a concentrated period of time.
Traditionally, to handle this increase in volume, firms have hired and trained seasonal or temporary workers to manually process open enrollment documents. This is an untenable solution in the long-term, costing companies additional time and money spent on paperwork, training and onboarding.
Manual data entry increases the risk of clerical errors, leading to additional work to review and rekey entries and delaying the release of insurance information to customers.
Why Health Insurers are Embracing Automation
With automation technology to reduce manual sorting and data entry, insurance companies can save time and money while modernizing their operations. By some estimates, automating healthcare claims payments could save insurers $11.1 billion a year, while automating open enrollment can save individual insurance companies approximately $500,000.
IDP software can streamline the classification and data extraction from a variety of healthcare documents, including:
- ACORD Forms
- CMS 1500 and 1450s/UB-04 Forms
- ADA Dental Claim Forms
- Supporting documentation such as itemized receipts, identity documents [e.g. license, passport, birth certificate], and income statements
By introducing IDP solutions into technology stacks and workflows, insurers can improve document processing throughput, reduce error rates, and unlock economies of scale – no matter the time of year, document volume or variability of incoming forms. And with the changes 2020 and the COVID-19 pandemic has brought to office work, it is more critical than ever for firms to move away from people- and paper-intensive operations.
But not all automation solutions are alike, and the complexity of healthcare documentation requires an Intelligent Document Processing Solution [IDP] that uses Machine Learning to reliably read different document types and images without having to create new templates or run rules in the background to achieve results and continues to learn in the background to deliver lower error rates and higher automation over time.
Using the Hyperscience IDP solution, for example, you can train a single model to handle all variations of common document types with as few as 400 sample documents and understand the difference between a case ID number and a member number even if the exact form hasn’t been processed yet. This results in less work for your employees and quicker response times and claims payments for customers – a win-win. And, with the time savings, companies can reallocate their other full-time employees to focus on more value-add customer-facing roles – a benefit for companies year-round.