Health insurance claims processing for billing and collections can be a long process. However, it is essential to any business that pays healthcare providers. One of the most valuable data sources for healthcare organizations is medical claims. To improve the cash flow, a health care provider needs to provide extra care to the medical claim processing sector.
Many service providers don’t have the experience, skills, and technology to handle medical billing. So, the best option is to outsource data entry services for medical claims processing.
What are Medical Claims?
When a patient is treated in a hospital, he/she has to pay for the services provided by the hospital. Each patient has health insurance that pays for the treatment. Thus, a hospital submits a bill to a patient’s insurance provider for claiming the amount. This bill is called a medical claim.
The claim provides the details on the services offered by the healthcare institution and the charges associated with it.
How are Medical Claims Processed?
Medical claims processing is an intricate process that must go through many steps before being approved. If a claim passes all the steps, the insurance company approves it and processes the payments, and if it doesn’t, it gets denied or sent back for more information.
The steps can be as follows:
- In the first step, health care providers prepare claims by giving specific codes to the medical services provided. The claim contains details like patient demographics and plans coverage details.
- The claim is then submitted to the clearinghouses. Clearinghouses act as an intermediary between healthcare providers and insurance companies. Once the healthcare provider submits the medical claims to a clearinghouse, they scrub, standardize, screen medical claims and send them to insurance companies.
- Next, the insurance companies carefully evaluate the claims. If there are no errors and issues, they reimburse them, or if there are any issues, they reject them.
What are the Challenges Faced in Data Entry Services for Medical Claims Processing?
Data is one of the most important assets of any organization. The healthcare industry, being a highly data-intensive industry, needs to focus on automating and optimizing the use of data.
If the industry can manage, integrate and harness vast piles of data, it can enhance its operational efficiency.
In the healthcare industry, the data collected is complex and is governed by excessive regulations.
Some of the challenges faced in data entry by healthcare providers are:
- Manual Data Entry:
Even now, many providers do manual data entry to store the information. Manually inserting the data could take a long time and result in more errors. It also requires ensuring patients’ privacy is protected and others do not access files.
Many healthcare providers have switched towards Electronic health records (EHRs). It is a web-based solution with built-in encryption that protects files from unauthorized access. They are used to capture and manage the information collected during patient’s appointments. EHR’s are secured and compact.
- Fragmented Data:
Healthcare providers have to record a lot of data, including patient’s information, intake forms, consent forms, health assessment, claims forms, etc. The data could be structured or unstructured. This makes the extraction and integration of data a big challenge for healthcare providers. It is easy to collect data but unifying them is a challenge.
- Data Interoperability:
Just collecting and storing data is not essential. But it is also vital that the data yields consistent meaning and is shared and transferred among people, organizations and systems. It consolidates patients’ data and gives them complete control over the sharing of their records.
- Data security:
Data security is one of the major concerns of all healthcare providers. During each transmission, data could be compromised. There has been an increase in cyberattacks recently. This leads to data breaches and invasion of private personal data. Keeping the data secure could be a huge challenge for healthcare providers.
- Changes in data:
Data in the healthcare industry changes constantly. Each patient undergoes a wide range of tests and treatments within a few years. So, ensuring that the data is updated every time and is efficient is also a challenge for them.
From the above challenges, we can surely say that data entry services for medical claims processing is a highly complicated process, extremely challenging, time-consuming and risky if not done properly and many healthcare providers cannot do it properly.
Their primary focus is accuracy, timeliness (i.e., processing claims quickly), and cost-efficiency. If these objectives are not met, it can cause headaches to the healthcare providers.
Healthcare providers deal with thousands of medical claims daily that has to be compiled and recorded. Any error in the data can cost a lot to the business. In this department, incorrect information could affect the well-being of human beings.
Data entry is not a core activity for a healthcare provider. Therefore, the purpose of improving the systems and processes is also limited.
Thus, rather than focusing on data entry for medical claims processing, they should focus on improving their medical systems, which will enable better care and support to individuals. Doesn’t that make sense?
If they do this job, healthcare providers will need to recruit a lot of staff, hardware and software to store and access that information, etc. However, if the team is not competitive enough to handle, it can cause many issues.
Hiring and maintaining staff only for data entry doesn’t seem efficient.
Due to all these challenges, healthcare providers prefer to outsource data entry services for medical claims processing.
Outsourcing these activities to a business process outsourcing can be a key to survival and growth.
What are the Advantages of Outsourcing Data Entry Services for Medical Claims Processing?
Outsourcing data entry for medical claims processing has many advantages:
- A healthcare provider can get easy access to a highly trained team of skilled, educated professionals who can handle the most complex of tasks through outsourcing.
- Business process outsourcing companies are focused and experienced in their task, which means fewer errors are reduced.
- By outsourcing the back-office work, the healthcare providers will focus on their core activities, thus providing the best services.
- Healthcare providers will also reduce their costs by outsourcing data entry for medical claims processing, as they don’t have to spend on resources for data entry work.
ARDEM provides data entry services for medical claims processing which improves and will help improve overall efficacy by lowering costs, increasing productivity and ease of use between all parties throughout the claims receivable and collection management process.
ARDEM has processed data from millions of forms. We have collected data from single page HCFA claims and claims accompanied by backup documentation. Claim entry has been done for health service providers and companies processing claims for receivables management.
HCFA1500 forms are just one type of health insurance claim form that ARDEM can process. The HCFA1500 details the numerous medical services the patient has received from the medical service provider.
In order for the service provider to get paid for these procedures/tests, often a third party Receivables Management Company must be utilized. This is where Data Entry Services for Medical Claims Processing from ARDEM become of value.
The medical claims receivable management company now utilizes ARDEM to collect medical data from the HCFA forms and create a database of outstanding claims. This can include but is not limited to extracting numerous fields including patient name, patient DOB, Employer, Billing Entity, Date of Service (DOS) Clean CPTa, INS name, INS Address, INS City, INS State, and INS Zip.
Suppose your company has large volumes of claims you process. In that case, significant efficiencies can be achieved by utilizing ARDEM solutions for data entry and data capture from forms such as the HCFA form.
Is your current workload of claims processing getting to be more than what you can handle in-house? Give ARDEM a call, and we will tell you all about how we can help with Data Entry Services for Medical Claims Processing.
ARDEM is HIPPA compliant and will reduce processing time while improving accuracy and overall profitability!
ARDEM can provide you with quick, reliable and accurate data entry services for medical claims processing.
ARDEM provides Business Process Outsourcing and Business Process Automation Services to established companies to help them improve operational Efficiency and Reduce Costs. For more information, please reach out to us at pricing@ardem.com or call us at 908-359-2600.
