Claims Processing System: For Improved Quality Of Service and Patient Safety

The world is changing and so are the health conditions. Advancement in technology and other fields has led to the transformation of the world; however, this development has not come without a price. It has resulted into enormous stress and evolution of a no. of diseases including HIV, various life threatening viral infections, and so on. The healthcare industry all across the world is facing tremendous pressure. The rate of healthcare inflation is much higher than the normal rate of inflation and this has led to a great increase in the no. of people seeking medical insurance.

The healthcare professionals/hospitals are required to maintain a large amount of data pertaining to health insurance claims. The data needs to be gathered from patients in a systematic manner, a no. of codes and other requirements are to be filled up before actually the claim is submitted with the insurance company or the intermediary. Often the manual process of claims processing results in to a large no. of errors, which ultimately results into claims rejection or delay in claims reimbursement. The situation is becoming worse day by day; healthcare professionals / hospitals are said to be spending their major amount of time with these back end functions resulting in very less time to concentrate on the core services.

There are various solutions cited by industry experts and the one that which has gone well with the healthcare industry is the implementation of healthcare systems like electronic claims processing system. The system aims at revolutionizing the whole process of claims processing and thereby making the life easy for healthcare professionals as well as hospitals. Till date, implementation of information technology was very low in the healthcare industry as compared to any other sector; however, the industry has understood the importance of healthcare systems. The problems encountered in the process of implementation are – costs, apprehension of failure of the system, training & support.

The costs spent in implementing an electronic claims processing system may be higher in the beginning, however, the long term benefits are huge. A lot of administrative costs can be saved by using the system, ultimately resulting into increase in the revenue for the practice. As far as failures are conce
ed, not all systems are alike… systems differ in capabilities. Hence, it is of utmost importance that the practice or hospital intending to implement the system tries to analyze the whole system very carefully before actually purchasing it. It is advisable to list down the requirements of the practice and to compare it with the features offered by the system.

As far as training and support is conce
ed, a claims processing system no matter how advanced it is, has no meaning if it does not provide for top class personalized training and 24/7 technical support. One has to be very careful in choosing a vendor; a vendor must be able to provide with a good demo of the product, product features comparison chart (with other products in the market), assurance as to dedicated training and good technical support for the product. The advantages of implementing the system are many both at physician/ hospital as well as patient level.

The electronic claims processing system aims at reducing the time spent in processing the data, improving the rate of claims reimbursement at reduced time limits, providing more time resources to the professionals, improvement in the quality of service and patient safety, reduction in administrative costs and improving the revenue for the practice / hospital.

Electronic Claims processing the advantages are many, however, at the core being "improved quality of service and patient safety".