Accurate insurance verification is essential in today’s bustling healthcare environment. With $262 billion in denials each year and additional costs ranging from $30 to $71 each missed claim, the financial impact of insurance errors and denials is enormous. Furthermore, even though 66% of rejected claims are recoverable, only 65% of them are ever revised. Healthcare providers need to choose between developing their own insurance verification automation systems and collaborating with specialist providers in light of these obstacles.
The Limitations of Traditional Methods
Paper and clipboard, digital intake, and OCR intake are examples of antiquated and ineffective traditional techniques for insurance capture and verification. Repetitive jobs cost 260 hours and 6.5 work weeks annually in manual labor, which has an error rate of 4.2%. With 30 years of existence, OCR systems frequently lack the necessary tools and have a poor success rate of 60%. Error-prone payer and plan routing, accuracy validation, insurer coordination of benefits (COB) management, and carve-outs are all challenges for these outdated systems.
The Case for Building Your System
Both benefits and challenges come with developing an AI-powered insurance capture and verification system. Possessing proprietary software that is customized for certain requirements and adaptable workflows are the main advantages. Additionally, building an in-house system allows for more granular control over data security measures, including credit checks and other sensitive information.
It is not without expense, though. A system of this type can cost anywhere between $1,000,000 and $5,000,000 to design, create, test, and deploy; maintenance and updates after the system is up and running will cost three times as much.
There are also high technical and expertise requirements. A very talented IT staff is needed to develop AI models, OCR capabilities, HIPAA EDI X12, HL7, web services, robotic process automation (RPA), and conversational AI for payer outbound call automation. Furthermore, to adapt to evolving payer plans, scale management, specialized data encryption techniques, and compliance and regulatory management must all be updated on a regular basis.
Risks and Rewards of Building
There are many dangers associated with building an internal system, such as delays, complexity, and possible loss of credibility. Years may pass between development and system maintenance, which calls for ongoing care and knowledge. A company’s credibility might be seriously harmed by any verification failures or data breaches. However, if the company can afford the substantial initial outlay and continuous commitment, having proprietary software grants total customization and control, which can be quite advantageous.
The Benefits of Buying a System
Purchasing an already-made insurance card capturing device is often a more cost-effective option for healthcare practitioners. The principal expenses pertain to API subscriptions and transactions, with minimum technical prerequisites other than proficiency in integration. A committed staff of software engineers for upkeep and upgrades results in up to 60% in support cost savings when you partner with a specialized provider, among other benefits.
In addition, pre-made systems are easily implemented, enabling firms to begin the insurance verification process right away. These technologies, which may save office personnel up to $14,560 annually per employee, are frequently simple to use and straightforward. The biggest risk is partner fit, so make sure vendors are fast and responsive enough for your needs by carefully vetting them.
The Best of Both Worlds
The advantages of purchasing a health insurance capture and benefit verification automation system is significant. In five seconds or less, an AI model, trained on over 4,000 payers and 20,000 plans by domain experts, validates data and verifies coverage. With a payer identification rate of 98.5%, the system can process a variety of document types, such as screenshots from phones, paper printouts, online wallet photos, referral letters, and lab requisition forms.
The powerful and feature-rich system makes automatic calls to payers as well as primary and secondary callers, offering a reliable and effective option for the future. It extracts data and, in real-time, maps, validates, and verifies it to the payer and plan type in the EMR/RCM. Businesses can cut expenses by 40% to 60% by using this system to automate the capture and verification of insurance cards.
Summing up
Time restrictions, technical competence, and budget are some of the elements that influence the decision of whether to construct or purchase an insurance verification system. Though it is expensive and complex, building a system gives you control and personalization. With continuous help from expert providers, purchasing a system is an affordable and expedient implementation strategy. In order to simplify insurance verification procedures, some companies offer a well-balanced solution that combines efficiency and personalization. Collaborating with these companies might be the most effective approach for numerous healthcare providers to get noteworthy financial benefits and enhanced operational effectiveness.
