TABLE 4-7How Could Administrative Complexity Burden Be Reduced if a Single Set of Rules Were Used?

Group Practice Management
  • Time to research and understand payer rules/guidelines would be reduced
  • Time reviewing and analyzing rejections would decrease
  • Work flow could be more streamlined and efficient
  • Time saved working transaction edits
Third Party
  • Reduction in rejection claim follow-up time
  • Reduction in effort to maintain different formats for scrubbed claims
  • Reduction in overall billing effort due to easily accessible online EOB information
  • Reduction in time working payer-specific TES edits and PCS work files
  • Reduction in time dedicated to Radiology bundling edits and Radiology local policy review edits
  • Elimination of all manual processing of paper checks and EOBs
  • Elimination of resources required to scan paper EOBs
Management Information Systems
  • Elimination of referral manager queues
  • Elimination of open referral module maintenance
  • Elimination of payer-specific dictionary fields
  • Reduction in time to implement 835 receipt files
  • Reduction in PCS work file compile routines
Customer Service
  • Reduction in volume of insurance-related questions
Payer Relations
  • Reduction in time related to the research of payer policies

NOTE: EOB = explanation of benefits; PCS = paperless collection system; TES = transaction-editing system.

SOURCE: Prepublication data prepared by the authors for research funded by the Robert Wood Johnson Foundation.

From: 4, Excess Administrative Costs

Cover of The Healthcare Imperative
The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary.
Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Yong PL, Saunders RS, Olsen LA, editors.
Washington (DC): National Academies Press (US); 2010.
Copyright © 2010, National Academy of Sciences.

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