Healthcare providers receive high volumes of Explanation of Benefits (EOB) documents from payer organizations. Quickly and efficiently processing the data in these documents is essential to avoiding consumer dissatisfaction and accelerating cash flows. However, many healthcare organizations continue to process such documents manually, making the process error-prone and time consuming. In fact, a key challenge is the prevalence of a high number of typing errors related to patient account number and reason code. So how can you transform existing EOB processes to avoid such errors and meet business objectives?
A modernized EOB processing automation platform is the answer. It can help you enhance service delivery to payer organizations by enabling systems validation, such as flagging of mismatched entries, and processing big batches on priority. Typically, big EOB batches (ranging from 3000 to 25000) are assigned a lower priority and processed later. Reversing this process can optmize productivity by processing a higher number of EOBs in lesser amount of time.
Incorporate seven must-have features
Here are seven key functions that your automated platform should have to drive quick and error-free EOB processing.
1. Well-defined user roles: An ideal EOB processing software should support defined roles for users for enhanced efficiency, access and security, a capability that is typically not available in legacy applications.
2. Automated batch download, allocation, and tracking: This will increase productivity, eliminate wait times, and help users prioritize sensitive and critical clients.
3. Easy copy-and-paste option: Reading data from scanned images can be done using Optical Character Recognition (OCR); however, that can be expensive. Instead, allowing users to easily copy patient information from the scanned EOB images into the work-in-progress files eliminates the need to manually key in information, reducing cycle time and human errors.
4. MPI ratio calculator: The Master Patient Index (MPI) is the central database of customer information. An MPI ratio calculator indicates whether the patient record matches this index, enables MPI analysis that helps identify patients with low MPI match rates, reduce mismatch, and improve data accuracy.
5. Quick keyboard shortcuts in the balancing grid: A modernized platform should support keyboard shortcuts in the line balancing grid such as cursor movements, and movement from one cell in the balancing grid to another cell using the Tab key, and so on. This can help reduce processing time by approximately four seconds on average, per transaction.
6. Instant detection of blank or dummy EOBs: While processing EOB batches, the processor sometimes erroneously creates blank and dummy EOBs. A modernized platform should be able to detect and restrict the submission of a batch containing faulty EOBs. This will help reduce rejections, errors, and overall processing time.
7. Agile report generation: EOB processing automation requires day-to-day monitoring and governance. A modernized platform should therefore support a wide range of reports: a user summary report can provide user-wise allocation status for a particular batch, enabling efficient allocation of work; a TAT report can provide visibility into batches pending processing, enabling the users to prioritize batches; a check level EOB report can provide the location of an EOB with respect to its image number.
In a rapidly changing healthcare ecosystem, optimizing time, cost, and resource utilization are increasingly critical objectives for healthcare providers. Resorce-intensive processes can cause major setbacks, resulting in sub-optimal outcomes for all stakeholders. A modernized EOB platform can drive better quality care, higher cash flow, and superior return on investment.
