Processing Medicare or Medicaid claims can be a hassle. Not only do they tend to include more attachments, but they also require a tighter turnaround time. Processing high volumes of paperwork in-house can be challenging—but when you add in the complexities of manual workflows, timely filing for Medicare/Medicaid claims becomes unbearable.
Partnering with a medical claims processor allows for faster processing at a lower cost because of machine learning, automation, and proven processes.
Smart Data Solutions is changing the narrative around complex Medicare/Medicaid processing. See how modern solutions put challenges with Medicare/Medicaid claims processing to rest.
Pain Points of Manually Processing Medicare/Medicaid Claims
The challenges with manual processing of Medicare or Medicaid claims center around two themes: timeliness and complexity.
- The timeliness factor lies in baseline requirements for filing a claim within 12 months. This is exacerbated by a higher rate of appeals for Medicare/Medicaid claims which increases the number of steps when processing a claim, as well as puts a stricter time limit on processing.
- The complexity of Medicare/Medicaid processing increases because of the higher number of attachments that come with claims and their associated appeals. At the end of the day, every additional piece of paper means it takes more time to turn around the appeals.
Fortunately, complexity and timeliness are the exact issues for which automation solves. To view the complete instructions for processing Medicare claims, view the manual.
Benefits of Automating Medicare/Medicaid Claims Processing
Paper will always be part of the healthcare claims processing workflow to some extent; but implementing automation into portions of claims workflows has a positive effect on cost, security, and time.
Automating Claims Increases Accuracy while Driving Down Cost & Turnaround Time
Perhaps the biggest benefit of incorporating automation into claims processing is the ripple effect it has on workflows, increasing their efficiency. Cost savings comes from reducing manual, time-intensive labor. Increased accuracy comes from machine learning and proprietary software such as Optical Character Recognition (OCR). Faster turnaround time comes from well-defined processes and fewer human errors.
Electronic Filing of Medicare/Medicaid Claims Improves Security
Concern over secure data transfer is common among healthcare practices because of the privacy of Protected Health Information (PHI). This concern is met with the rigorous standards that companies are required to follow when working with PHI. Smart Data Solutions for example is HIPAA compliant, HITRUST certified and conducts regular audits of systems and internal practices to ensure they are fully compliant. It behooves any third-party claims processor to meet top-tier security standards in order to create a secure infrastructure capable of handling sensitive information.
Outsourcing Medicare/Medicaid Claims Streamlines Healthcare Processing Workflows
This real-world scenario shows how outsourcing healthcare claims processing simplifies workflows. For clients that offer Medicare supplemental plans, Smart Data Solutions can help manage the CMS connection. We are able to take existing membership data and format it into the expected E01 format used by CMS / GHI. We coordinate and manage this ongoing E01 data exchange in parallel with the inbound 837 claim receipt from the CMS.
Additionally, if we’re performing paper conversion to EDI, we can receive the claims with EOB attachments and run a duplicate check on the ICN to identify any duplicates. Medicare claims are more complex than typical healthcare claims—but processing them doesn’t have to slow down your internal workflows.
Medical billing processors help healthcare providers determine which portion of their administrative workflow could benefit from automation. In many cases, in-house teams appreciate seeing the benefits of automating a portion of their claims workflows before rolling out a widespread automation effort.
Smart Data Solutions can provide guidance on a number of processing services including paper to EDI conversions, data exchanges across multiple partners, improved adjudication rates, and automating appeals. View our medical claims management services or contact us to get started on streamlining your claims workflows today.