End the Paper Chase in Healthcare Billing

I received a message from a colleague about Dr. Emanuel’s article in the Opinionator column of the New York Times on Nov. 12.

Ezekiel points to something we must do to reduce overall healthcare costs: put a stop to the intense paper chase in healthcare billing and go electronic. We have the systems, technology and know-how to do this.

Moreover, it was the original promise of EDI in healthcare to streamline administrative tasks…and we’ve seen much of that happen on the claims side but not on the payment side.

I admire the way Ezekiel lays down a pragmatic framework for reducing billing costs, and I recognize that “receiving payment” is a huge bucket that can transform business practices in healthcare. This area alone could yield $11 to $35 billion in annual cost savings.

It is natural to think that when a payment is received that everything is done. But I want to emphasize that this is not true of healthcare. Receiving the payment is often the first step of a lengthy process for obtaining full reimbursement. 

First, the payment itself must be reconciled with two entirely different systems – the banking system and the patient accounting system. Knowing how the account was paid is a critical part of reconciliation. The remittance data that comes with the payment tells the provider what was paid and often, what was underpaid or not paid at all and the reasons. 

But it doesn’t stop there.

There are other steps providers must take to ensure that their books are “clean.” Once all this data is crunched, the hospital, practice, and even the consumer, has the right data each needs to manage their business or healthcare expenses.

Automation of these healthcare after-payment activities – which ultimately lead to good business intelligence – is an area of practice called “medical banking” that the HIMSS Medical Banking Project has supported since 2001.  This community meets annually to understand the potential of new business practices and to show how they are impacting healthcare business transformation.  

In February 2012, at the Annual HIMSS Annual Conference & Exhibition, we are revamping our program to provide the necessary resources to hospital CFOs and their revenue cycle staff.  The new “Summit for Healthcare Information and Financial Technology” will offer excellent educational programs and insights that build on the ideas mentioned in Ezekiel’s article.

Ezekiel Emmanuel offers pragmatic advice that the community should heed. HIMSS welcomes and supports this critical dialogue to facilitate electronic business transformation.  

As demonstrated by our work at HIMSS12, we aim to inspire a new focus on business transformation and innovation in healthcare that will transfer the cost of this paper chase into savings that providers need to care for their communities.