Wednesday, March 11, 2009

It's All About The Data

By Mark Brousseau

Why all the fuss about automating the processing of explanation of benefits (EOB) documents? Foster North, vice president, CareMedic Systems, thinks it’s because the ANSI 835 information set – the electronic counterpart of EOBs – is one of the industry’s most important information sets.

“It’s important because of the information that it provides hospitals on how well their revenue cycle management processes are running,” North said today during a presentation at the Seventh National Medical Banking Institute in Nashville, TN. “For instance, if you are not able to capture denial information and analyze it in a meaningful way, your hospital likely won’t be able to get paid.”

North thinks there is an opportunity for bank lockboxes to take both the electronic remittances and paper EOBs that come from payers, and put them together in a common repository so providers can review them electronically, post them easily, report the data more effectively, and analyze the data.

In the past, a hospital might have needed 100 people to manually post payments from paper EOBs, North said. “It is a laborious process to post that information,” he said. “But the real return on investment and value in automating this process is the value that bank lockbox providers are able to give their customers from their data-rich remittances on how to improve their revenue cycle.”

North thinks remittance reporting will become prevalent in the future. Other services he sees as key:

… Secondary billing
… Statement fulfillment
… Denial management
… Contract management
… Remote deposit services for independent physicians

“All of these are fair game when you are considering a strategy for the future,” he said.

What do you think? Post your comments below.

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