U.S. health care industry would save $ 16.3 billion per year by fully automated nine ordinary administrative transactions, subsequent 2020 CAQH Index – thanks to a decrease in the cost of automated processes and higher costs of manual and partially electronic portal processes. “This year’s report found that the adoption of electronic processes generally increased across the medical and dental industries,” Kristine Burnaska, director of research and measurement at CAQH, the nonprofit alliance of health plans and related associations, said in a statement. “The data also indicates that future efforts to automate could yield even greater returns.”
Related: Not just the bills: The health service’s administrative ‘slam’ eats up employees’ time The CAQH Index tracks automation, expenses, and savings opportunities for administrative transactions related to controlling patient insurance coverage and cost sharing, obtaining permission for care, submission requirements and additional information, and sending and receiving payments. It categorizes transactions by whether they are fully automated, partially electronic or manual. (2020 Index collected data from health plans and providers through the 2019 calendar year and does not include the impact of COVID-19 on health care administrative transactions.)
Although the industry has already saved $ 122 billion a year by automating administrative transactions, the index points to opportunities for additional savings. For example, each fully automated claim status examination costs $ 11.71 less than the same transaction made manually for the medical industry and $ 10.92 for free industry for the dental industry.
The 51-page report also states that the costs associated with some manual and partially electronic portal transactions are increasing as healthcare business needs become more complex – and as manual processes to accommodate them require more manpower and expense. In an “industry call to action” 2020 CAQH Index notes that “more transactions offer the greatest potential for savings and thus should be in focus”. the alliance’s recommendations include the following:
- Focus improves to address cost savings opportunities. “Qualification and advantage verification, The top savings option for medical plans and providers, saw a 37% increase in savings opportunity due to higher volume transaction, higher manual and web portal costs, and lower electronic transaction costs, ”according to the Index.
- Accelerate standards and develop operating rules to meet emerging markets. need. It is crucial to enable automation across trading partners and streamline administrative processes, the index says.
- Capitalize and expand your progress so far. “Pre-authorization remains one of the most complex and cumbersome transactions in the medical industry,” according to the index. “Electronic adoption increased by eight percentage points, the highest increase in adoption among the medical transactions in the CAQH index for 2020. This corresponds to public and private sector initiatives related to reducing the overall administrative burden associated with this transaction. ”
“The results of the 2020 CAQH Index are encouraging,” said April Todd, senior vice president of CORE and Explorations at CAQH in a announcement. “The data show that the potential for building on past progress – and achieving further savings that payers and providers can invest in patient care, innovation and expanding access to communities across the country – is significant.”
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