AASCIF - april-may-june03 Medical bill imaging

By Rob Norris
Chief Information Officer
Colorado, Pinnacol Assurance

Several state funds have implemented document imaging systems to enable paperless management of key business files, primarily policy and claim files. Other funds have, for years, contemplated implementation of imaging technology but have made little progress because of project complexity, immense business impact and high cost.

One strategy to introduce document imaging into a state fund, while minimizing complexity, impact and cost, is to implement an imaging system for medical bills.

A medical bill imaging system involves scanning incoming paperwork associated with healthcare claims, primarily standard forms UB-92 (for inpatient hospital care) and HCFA-1500 (for most other healthcare), along with associated records and notes.

As forms are scanned, optical character recognition (OCR) technology reads the information on the forms, creating a stream of electronic data. The data, along with images of the forms, is used to drive the workflow for bill adjudication, while the original paperwork is temporarily retained as a back-up and then eventually destroyed.

The most obvious benefit of such a system is the elimination of data entry, which can account for the majority of labor costs involved in adjudicating medical bills.

However, OCR does not eliminate all manual data entry. There still must be a data verification process that involves human beings.

As the OCR engine reads data from bill images, it assesses its own confidence on the accuracy of its output. When the engine falls below a certain confidence threshold, it displays to a worker what it “thinks” it has read, along with an image of a relevant portion of the bill. The worker then can validate the data against the image, making changes if necessary.

After OCR, a medical bill imaging system can perform a series of additional edits, such as authentication of procedure and diagnostic codes, validation of mathematical totals, and look-up of geographic data. These edits are highly configurable and can be integrated with existing claim and medical bill processing systems.

Quicker access to records
Medical bill imaging can have a favorable impact on more than just expenses.

Losses can be driven downward because claim adjusters and nurses gain access to medical bills and records sooner, allowing for more-informed, timelier decision-making. With a medical bill imaging system, images of bills and records can be immediately and simultaneously accessible by anyone who needs them. Without an imaging system, bills and notes often go through the bill adjudication process first before being sent on to other employees.

Medical bill imaging can also facilitate better quality control and workload management.

With images and data going into a database almost immediately upon receipt of bill paperwork, bills can be tracked more reliably. It’s less likely that bills will be lost or thrown away. Simple workflow mechanisms can be built to equitably balance workload among bill processing workers.

And post-adjudication quality review procedures can be implemented that allow an auditor to easily retrieve a random selection of bills, including images of the original paperwork.

Imaging products on the market
Because processing medical bills is not unique to workers’ compensation, there is a robust market for packaged medical bill imaging systems, supplied by several well-established document imaging vendors.

Products such as MEDIclaim by Cardiff Software Inc. and ClaimPack by Captiva Software Corp. can be purchased for a surprisingly reasonable cost and implemented in a few months. Labor savings alone can pay for such a system in as little as one year.

Vendors typically provide extensive implementation assistance through consultants who are well versed in the intricacies of processing healthcare claims. This enables the state fund to focus primarily on the integration of the product into the overall bill processing and claim management environment.

The “paperless office” in workers’ compensation may for some time remain an elusive goal for many state funds. Instead of sitting on the sidelines, state funds should consider medical bill imaging. It provides an easy and affordable way to open the door to document imaging, while offering an attractive and almost immediate return on investment.

Rob Norris can be reached at ROB.NORRIS@PINNACOL.COM
or phone (303) 361-4641.

Medical bill imaging is a way to try out the advantages of the paperless office

Medical bill imaging is a way to try out the
advantages of the paperless office