If Tom Brady was in healthcare payment processing, he’d get to 100% automated posting of insurance payments… but he wouldn’t get there the way you think.
Does he have the physical tools? Sure – – but that’s not enough. Attention to detail, discipline and hard work factor in even more than a strong arm. As much as I hate to admit it, Brett Favre (my favorite), had all the tools as well, but he’s only won one Super Bowl.
It’s much the same with getting to 100% electronification of healthcare payments. You can have all the latest technology in the world, but if the training, teamwork, and commitment to automation of tasks isn’t there, it’s gonna be four-and-out most of the time! (That means punting.)
You can’t just simply sign up for electronic EDI 835 remittances and ACH payments from payers (insurance companies) and have it post like magic. You have to go through the effort to do so, then test posting as well as reconciliation. When providers have tens and hundreds of payers, the task can be overwhelming and requires staffing which may not be available.Typically providers pick the top payers with insurance claim volume and then handle the rest with paper. This gets you 50-85% electronic.
The rest of the paper is usually gathered somewhere, i.e. lockbox, clearinghouse, backoffice, or payment aggregator. These locations, many times, don’t have the technology to convert paper into electronic data, so they either push the image to the provider who keys in the remittance and payment data, or they key it themselves. (Punt!)
Methodically moving down the field, confident with each transaction extracted from every EOB; everyone knows their assignments. Soon you’re closing the gap on remaining EOBs, correspondence, and patient payments and… TOUCHDOWN — generating EDI 835 for automated posting!
2 point conversion? You use HPAC for research — you’ve prepped, so it’s not a problem.
Now it’s overtime and you’ve won the toss. Can you smell the end zone?