Using Todays Technology to Increase Efficiency, Accuracy, and - - PowerPoint PPT Presentation

Using Today’s Technology to Increase Efficiency, Accuracy, and Productivity

Presented by:

Today’s Presenter

Shamel Naguib

President of Paperless Productivity, Inc.

• 20 years of experience in electronic fax

and document workflow for healthcare

• ABC News - fax SME (Subject Matter

Expert)

• “Expert” on American Idol Voting techniques
• Connecticut Green Guide – paperless SME
• The Guardian – paperless SME
• Favorite books
• Cheaper by the Dozen - Carey & Gilbreth Jr.
• Oh the Places You’ll Go! – Dr. Seuss

Paperless Productivity, Inc.

• 15 years of systems integration using best-of-breed OCR,

RightFax fax server, and mailroom technology

• 9 years as a Senior Consultants with Advantage

Technologies, Inc., the # 1 integrator of RightFax in North America

• Fax server / software and Fax-over-IP (FoIP) technology

experts

• Optical Character Recognition (OCR) experts for fax
• Automated Prior Authorization, Accounts Payable, Accounts

Receivable, Claims, and other Workflow

• ClaimsCapture for CMS Claims processing automation using

OCR technology

• Global Mailroom, Business Process Automation, End-to-End

Service Provider for Payers and Providers

• Complete Professional Services for

Implementation, Support, and Training

• Representatives in Seattle, Portland,

San Francisco, and New York

• Mailroom & Outsourced Services on

6 Continents, 24x7x365

Some of Our Clients & Friends…

Today’s Focus…

Simple, effective, quick-to-market technology solutions that leverage existing technologies along with sophisticated and proven techniques to reengineer Fax- and Scan-centric workflow into fully automated or partially operator-assisted digital

• transformation. We will discuss real-life examples of

how other payer organizations have been able to significantly reduce costs while also increasing SLAs in less than 12 months from project inception to ROI realization. These examples will come from workflows around fax, mailrooms, and other document heavy processes.

Topics include:

• Challenges facing healthcare organizations
• Issues for payers and providers
• Obstacles to interoperability
• The problem of paper documents
• Existing technology
• Solutions to everyday manual processes

Challenges Facing Healthcare Organizations

Payers

• Claims Processing
• Many claim are still received on paper
• Manual data entry for processing
• Average annual processing cost: $210 billion
• Prior Authorization Fax Automation
• Typically come in via paper fax
• Time-sensitive process
• Requires manual scanning, data entry, and indexing
• Integration with legacy systems
• Many homegrown or custom systems require paper

processes and manual data entry

• Often very big investments
• Usually better to refine than to start over

Providers

• Health Risk Assessments, Surveys & Questionnaires
• Typically come in via fax
• Measure performance and satisfaction
• Manual data entry
• Inbound fax automation
• Most inbound documents arrive via fax as unintelligent images

and require a lot of user intervention

• Healthcare providers are still exchanging 75% of PHI via fax
• IDC White Paper | Fax Market Pulse: Trends, Growth and Opportunities.

Authors: Ron Glaz, Holly Muscolino. June 2017

• Integration with legacy systems
• Some EMR/EHR implementations are many years old;

tech has changed!

• Cloud tools (especially SaaS) growing, but only for certain niches
• HIMSS Analytics 2017 Essentials Brief: Cloud
• Need to step outside training/background

just to keep things running

Continued Challenges for Payers and Providers

Biggest Problems with Fax

• Time employees spend sending and receiving paper faxes is wasteful
• 42% of organizations say this is their biggest challenge
• The cost of paper-based, manual faxing is too high
• 39% of organizations say this is their biggest challenge
• Mailroom routing often necessary, always painful
• Prone to classification errors
• Usually reliant on legacy capture software (if any)
• Average cost: nearly $20 per document!

Source: Dr. Gerhard Wohland & Matthias Wiemeyer – “How Dynamic-Robust Organizations Create Market Pressure”

• Capture automation largely unexplored
• Only 45% of organizations use or plan to use capture tools

to digitize from paper

Source: IDC’s Fax Survey, February 2017

Continued Challenges for Payers and Providers

Biggest challenges with manual data capture

• Speed is critical
• Average payer receives over 1,000,000 CMS-1500 claims per year

Source: http://nucc.org/images/stories/PDF/nucc_survey_1500_form_2017_results.pdf

• ...but so is accuracy!
• 30% of claims denied at first, often due to simple errors

Source: https://www.hbma.org/news/public-news/n_where-your-clients-might-be-losing-money-in-their-practices

• Scaling is linear and not cost-effective
• Handwritten claims forms are still common
• Constitute nearly 1/5th of all provider CMS-1500 submissions

Source: http://nucc.org/images/stories/PDF/nucc_survey_1500_form_2017_results.pdf

• Rapid technical evolution and new buzzwords to track

Obstacles to Interoperability

Obstacles

• Wide variety of healthcare systems with

no link to communication

• Each one is (at least) a little bit custom
• Architecture and code vary wildly
• Payer and provider communication is challenging
• Lack of seamless integration between

workflows and data exchange

• Plenty of data exists, but it's hard to use in normal,

manual workflows

• Over time, orgs get more—not fewer—data sources
• Health IT implementations limited by

sub-optimal workflows

Sources for Further Reading

• http://www.managedhealthcareexecutive.com/business-

strategy/six-healthcare-interoperability-barriers-watch/

• https://www.researchgate.net/profile/Iroju_Olaronke/publication2

82322922_Interoperability_in_Healthcare_Benefits_ Challenges_and_Resolutions/links 560bada308ae6de32e9a457a.pdf

• https://heinonline.org/HOL/LandingPage?handle=hein.journals/wa

shjolta3&div=21&id=&page=

• https://www.healthcare-informatics.com/news-item/ehr/survey-

workflow-design-key-improving-quality-health-it-implementation

Paper, Paper & More Paper

• Most document exchange still via fax or mail,

yielding a baffling amount of paper

• Orgs "about to stop" using fax...for 20 years!
• Meanwhile, usage has grown 25% year-over-year

across all industries

Source: IDC’s Fax Survey, February 2017

• The big question: how do you keep your head

above the flood of paper?

• Can technology squeeze data from paper

documents and faxes?

• Does manual capture/input make sense?

If so, is outsourcing prudent?

• As one person/org, do you try to stop the deluge?

Do you just try to make it more manageable?

How do we overcome these challenges?

Technology Today

• What's in the toolbox?
• RPA – Robotic Process Automation
• OCR – Optical Character Recognition
• Electronic Fax
• What can they help you accomplish?
• Digital Transformation
• BPA – Business Process Automation
• Key takeaway: tools already exist

to automate manual processes! What will you build with them?

Tactics to Fight the Healthcare Giant: Manual Workflows

1. Eliminate the mailroom

• Offload scanning to senders, then it's effectively free to your org

2. Eliminating paper faxing

• IDC research: 36% of organizations still use old-fashioned faxing

methods, which will barely dwindle in the next two years (to 28%)

3. Eliminate scanning paper into the EMR

• Start & stay paperless when possible
• Use OCR to digitize effortlessly when paper is inevitable

4. Eliminate data entry

• Intelligent data capture tools have made hand-keying unnecessary

5. Eliminate data errors

• The sharpest human workers are still human; rules-based tools and

RPA end the errors

Reinvent & Reengineer with Exceptional Technologies

Our specialty: process automation with fax and OCR

• Expertise in RightFax and cloud-based fax technologies
• Out-of-the-box OCR solution that automates manual data entry

for healthcare claims (CMS 1500, CMS 1450, ADA J430D)

• Other prebuilt OCR solutions for:
• Health Risk Assessments
• Surveys
• Biometrics forms
• Prior authorizations
• EOBs
• Any other recurring document types

Examples to follow…

Claims Processing

Case Study: County Health Care Agency

From 100 paper claims in days to 100s each day!

ISSUE: County was processing over 100,000 paper claims manually each year

After

Using Paperless’ claims processing solution, the county was able to process over 100 claims in two hours when it took them two days prior. Additionally, all the data is able to be directly exported in their desired EDI 837 format!

Before

Processing both CMS 1500 and CMS 1450 (UB-04) forms and spending hours each day with manual data entry, rule reconciliation and data validation issues.

Health Assessments

Case Study: National Health Insurance Company

Before

Processing up to 6 different form types with hand written text. Typical backlog of more than four weeks, and lots of overtime.

Processing time falls 95% while accuracy hits 100%

Issue: Manually processing 120,000 health assessment pages/month

After

Created layouts with the Paperless Solution to automate the extraction of client data to process and export to Cognizant-TriZetto. Wet signature is required, so forms can be filled out by hand or as Adobe PDF before faxing to insurance provider.

Result

Forms processing time reduced to 4 hours, overtime eliminated. Significant increase in cash flow.

Processing time cut by over 95%!

In Summary…

Don’t throw the baby out with the bathwater! And don’t keep waiting!