Interoperability in healthcare — when done right — means seamless communication between systems. But too often, systems don’t talk to each other, leaving billers to fill the gaps manually. This doesn't just waste time; it costs your practice real money. And a lot of it.
The Cost of Manual Workarounds
Every day, billers are forced to log into multiple systems, manually entering data into one after retrieving it from another. Whether it's reconciling payer reports with practice management systems or updating patient eligibility details, each task eats into time that could be spent on revenue-producing activities. When system A doesn't speak to system B, the biller becomes the translator.
Consider this: if a biller spends an extra two hours a day on manual data entry, that's over 500 hours a year per biller. At an hourly rate of $20, that's at least $10,000 per year per biller in just salary costs. Not to mention the productivity loss — billers could be using that time to chase down unpaid claims, manage denials, or improve collections.
The Impact on Denial Management
Denial management is where interoperability issues hit hardest. A denial code might appear in a payer's portal, but if it's not accurately reflected in the practice management system, it can lead to delays in resubmission or appeals. Missing a timely filing deadline because a denial wasn't visible in all systems can be the difference between a paid claim and lost revenue.
Take the common denial code CO-197 — "Precertification/authorization/notification absent." If the authorization details aren't automatically updated across systems, billers are left hunting for information that should be readily available. This isn't just inefficiency; it's a revenue risk.
Delays and Errors
Errors to manual entries are inevitable. When billers are forced to enter data by hand, errors creep in — a mistyped code, a wrong date, incorrect patient information. Each error can lead to claim rejections and further delays. Correcting these mistakes only adds more hours to an already overloaded system, leaving less time for critical activities.
And let's face it, payers aren't exactly known for their speedy responses. When a biller finally catches an error and contacts a payer, they're often subjected to long hold times. Meanwhile, revenue sits in limbo.
Patient Experience and Satisfaction
Interoperability failures don’t just affect the back office. They impact the patient experience too. When systems don't communicate, patients might find themselves repeatedly furnishing the same information at different points in their care journey. This redundancy can lead to frustration and decreased satisfaction.
For instance, a patient may verify their insurance information during a check-up, only to be asked for the same details at billing because the systems aren't in sync. Not the best way to keep patients happy or loyal.
Finding the Right Integrations
So, what's the answer? Finding systems that truly integrate can be challenging. Vendors will promise the moon, but it's crucial to dig deeper. Investigate whether "integration" means full data exchange or just a basic API connection that still requires manual intervention.
Does the system auto-update across platforms? Can your EHR push updates directly to your billing system? These questions matter. A truly integrated system should eliminate the need for redundant data entry.
A Real Forward Look
The healthcare industry is slowly moving towards better interoperability, but practices can’t afford to wait. The financial impact is too significant. Those who invest in real interoperability today will be the ones best positioned to maximize revenue tomorrow. Practices should prioritize this when choosing new systems or evaluating current ones.
Interoperability isn’t just a tech buzzword — it’s a practical necessity. It's time to stop letting system failures drain resources. Investing in real solutions can reclaim lost hours, improve accuracy, and most importantly, keep the focus where it belongs: on delivering care and driving revenue.
Related Articles
