Shaped by great institutions, innovative ideas, and varied public interest, American policymaking is one of the finest in the world. However, its healthcare system as a whole is pretty convoluted! The federal government has taken many positive steps to make health insurance accessible to all the citizens, particularly in segments of people who are 65+ & those belonging to the lower-income demographics. Still, health insurance claims remain complex and costly. Especially the medical billing & claiming procedure! Thanks to the cloud-based VoIP Technology with CRM capabilities, the process has become a lot easier. How does VoIP Technology help?
Medical claim & billing is complicated, dynamic, & completely information-based. There are a number of things involved in it, including insurance details, patient info, and several other things for reference. And, to claim insurance means clearance of medical billing on the first hand, which seems to be a Herculean task. To avoid claim rejections most of the leading organizations with their business related to the medical claim process now need an IT-based solution to identify, monitor, and analyze different metrics.
American Healthcare Insurance System – Basic Information:
To understand the process in detail, let’s have a quick look at the healthcare insurance system in the USA.
The healthcare insurance sector is divided into two main categories:
- Medicare or Affordable Care Act (ACA): For US citizens, aging above 65. It has a centralized law & all the states adhere to it.
- Medicaid: For those who come under the low-income category. Every state is authorized to have its own set of rules that varies from state to state.
Coming to Medicare Insurance, it is again divided into 4 categories.
- Part A: Insurance cover for the medical expenses in the hospital
- Part B: Insurance cover for the medical expenses outside the hospital
- Part C: Covers both of the above (Type A & Type B). ODAG Universe – 14 Universe
- Part D: Covers pharmacy expenses. CDAG Universes with – 16 Universe
Understanding the Path of a Claim:
Upgrading the claim process is a widely shared goal whose accomplishment won’t be that easy. The insurance claiming system involves thousands of payers, millions of providers, and many plans, technologies, treatment options, and standards, all of which overwhelm any hope of finding an elixir.
To get a better insight into the complex claim system, consider someone who is rushed to a hospital for emergency heart surgery or any kind of illness or injury that needs immediate medical attention. The chances of that person getting the full recovery amount might be favorable. However, if the hospital authorities couldn’t authorize the patient’s eligibility when he or she is admitted, the chances of getting a claim paid on time are not so good and that to be for the accurate amount. Given the nature of emergency procedures, the claim could be sent back for a number of reasons.
To further perplex the matter, there are three stakeholders to whom the claims need to be submitted for payments: 1. Hospital, 2. CMS Authority, and 3. The Insurance Company. On a typical day, medical providers receive millions of claim requests. A single error & data miss-match in a patient’s form for e.g, Beneficiary First Name, Last Name, Patient-ID, Contract-ID, Character limit, for example, will result in rejection.
Suppose, you have ordered something from Amazon and you knowingly or unknowingly put the wrong address on the board. Do you think it will be delivered to your address? Of course not! Similarly, you must check for the validation of your documents, followed by CMS guidelines while making a claim.
So, what’s the best solution?
Data unlocks the path to improvement. And, most healthcare finds it difficult to sort, link, and retrieve clinical and financial data, & it’s a fact that no one can deny. To effectively manage these huge volumes of substantial data, healthcare service providers need data sharing and analytic tools that offer resilience to source and sort data from various channels to produce meaningful sights.
How VoIP Technology simplifies the complexity of the healthcare systems?
VoIP Technology, cloud-based software aims at eliminating errors from the database that result in payers’ denying or underpaying claims. The software points out the errors that are likely to hamper timely and accurate payment. It is incorporated with the latest CMS rulebook or guidelines to check the errors.
The documents go through a rigorous filter check:
- Schema: It checks the count of columns, sequence, spelling, predefined character limits, & more. If not follow the CMS guidelines or exceed the character limit, it won’t move to the second stage till you get them right.
- Data: If schema gives the green signal, it checks for the validity of data. If not, then it will show errors in that particular column, just at a click (Checking, missing, incomplete, invalid data).
- Business Logic Equation: It will come into action when both of the above found correct, but still some data are logically incorrect. It will check it out & asks the user to put the right info until it shows zero error.
How can we help you?
Improved financial, clinical, and operational outcomes are thus a function of automation. With a properly managed database system, it becomes easier to qualify for an insurance claim. We can help you with that. Our cloud-based solutions provide real-time actionable data to help hospitals exceed their previous performance, maintain data accuracy, save time, and enhance patients’ satisfaction. It does not allow errors to propagate, and claims are submitted clean, error-free, then over 90% can be paid after the first submission.
Are you a healthcare system or insurance company that is looking for cloud-based software, for the smooth operation of insurance claims? You could not have found a better software service provider than VoIPTech Solutions. We offer you a robust and fully functional AI-powered cloud-based software solution that makes the claims a hassle-free experience with CRM integration. You just need to tell us your requirements and our technical support team will come up with a few suggestions to ensure the solution meets your needs. One software, many solutions!
Sign Up and get FREE $5 credit today! For more info, call: +91 7008220621.