Challenges of Insurance Claims in Healthcare
An essential part of healthcare is the acceptance and billing of the appropriate health insurance. Oftentimes though, insurance claims are much easier said than done. Once everything is said and done, anywhere from $30 to $71 is lost for every claim. This staggering $262 billion in insurance denials reaches such a high mark because 65% of all claims that are denied never get reworked. Despite this large percentage, 66% of the 65% is recoverable and can ensure the healthcare provider gets due compensation.
One of the largest factors contributing to insurance denials and lost claim money is the method by which insurance information is captured. The tried and true ‘paper and clipboard’ is often employed, however this antiquated method has a significant chance of human error. In fact, around every 1 in 25 claims contains an error.
Similarly, you can manually input health insurance information digitally. Unfortunately, it suffers the same susceptibility to human error. It is also much more time-consuming than paper and clipboard. An estimated 5 hours a week, or 260 hours a year, is spent doing simple repetitive and tedious input of insurance data.
Solutions for Capturing Health Insurance Information
There has also been new innovation in insurance card information. Optical Character Recognition (OCR) technology eliminates human error and manual labor from the insurance capture process. Unfortunately, its novelty is also its downfall. It only has a 60% success rate, meaning its work often needs to be redone.
To properly and accurately capture health insurance information, you need systems uniquely designed for that purpose. You can either build your own system or choose to partner with a company that already developed those systems.
When electing to develop your own systems, there is a very large investment of both capital and time. From design to implementation, it can cost as much as $5M and take upwards of a year to complete. On top of that, you need a team to maintain the system once its complete. You need to pay the team, pay to train them, and pay for the parts that need to be fixed. However, this only considers the physical costs associated.
Conversely, you can choose to purchase an insurance card capture system instead. You only have to pay for API subscriptions and transactions, drastically lowering the costs involved. On top of that, you don’t have any time investment since you are purchasing the system. You also can skip out on the need for an IT team, as the system vendor should offer one. While there is much less risk than creating your own system, you leave yourself entirely vulnerable to the reputation of the vendor. An unresponsive or untrustworthy vendor can severely harm your business by hampering the insurance claim process.
Fortunately, Orbit helps to bridge the gap between making your own system and purchasing one. With Orbit, you get the benefits of customizability and cooperation, mixed with proper credibility. On top of that, their systems are incredibly functional. Accepting a variety of healthcare ID formats, they can validate, verify, and map payer and plan type all in 5 seconds or less for over 20,000 different health insurance plans. Whether you’re looking for a way to cut down on insurance claim denial or you are looking to save costs by automating insurance card verification, Orbit has a way to benefit your business.
Source: Orbit Healthcare
