By Lief Goodson, COO and SVP Analytics, Xerox Workers’ Compensation Solutions
The traditional ecosystem that supports the life-cycle fulfillment process for workers’ compensation can be complex – and not as effective as we’d all like. It can work better.
By definition, an ecosystem is made up of living parts, their physical environment and the relationships that connect them.
If we view medical cost containment as an ecosystem, we see systems for ingesting medical bill and claims data and storing the digital and analog artifacts. We see the medical bill review rules engine and the related infrastructure for workflow and compliance. We see integrated supply chain solutions for utilization review, negotiation, PPO and specialty networks, as well as provider payments. And increasingly, we see a growing number of sophisticated data analysis and decision-support tools.
Each time medical bill data and associated claim information are exchanged and duplicated or “persisted” across this typical ecosystem, it not only adds cost and complexity, but also puts the security of personal information at greater risk.
What if we could reduce the number of integration points, enabling the ecosystem to become more fluid in responding to opportunities, easier to measure from a holistic perspective and less prone to risks?
Bring It All Together
A holistic approach starts by seamlessly connecting data capture services with medical bill review software. Pre-integrating these components reduces implementation timelines, decreases replication risks and allows you to establish a single system of record for the adjudication process. Simply put, it’s easier and safer to provide access to all relevant artifacts in the review process – this includes audio recordings, videos, and links to warehoused data elements that are relevant to the claim but outside of traditional medical bill and claim data – through a single repository.
The fusion of data consumption, custodianship and medical bill review can reduce implementation time and cost, and simplify system updates. It can also mitigate the risks of data gaps and errors at various steps in the workflow while enabling a “single source of truth.”
Analyzing large sets of medical bill review and claims data is ideal for spotting trends and patterns to execute a quick response. Applying analytics to assess the workflow itself, in addition to the other solutions deployed, is also important.
Often, these solutions are integrated with the medical bill review platform, which drives the workflow and its configuration for the adjudication process. Typically, these are integrated third-party solutions, such as utilization review and negotiation services, audit and waste detection services, and PPO/specialty provider networks.
The Last Mile: Provider Fulfillment
Integrating provider payment management ensures prompt and accurate payments after final bill adjudication. It also improves the adjudication workflow by addressing the manual work required to match medical bills to the issuing providers or to track down missing documents required to determine compensability.
As solution providers with sizable volume invest deeply in the accuracy and currency of their provider databases, an integrated payment platform becomes an extremely effective tool for reducing remedial work, such as correcting errors and omissions at the outset of the adjudication workflow. A growing trend is to add a secure, provider-facing portal. A portal keeps providers informed during the entire adjudication process, decreases the number of inbound phone inquiries related to bill payment status, and reduces or eliminates the need for outbound call center staff.
While the ecosystem supporting the life-cycle fulfillment process from bill creation to bill payment for workers’ compensation can be complex with expensive implementation and augmentation costs, it doesn’t have to be. Selecting a solution that leverages a common data repository reduces integration and implementation timelines. It also decreases the risks associated with sensitive data proliferation, while providing the foundation for continuous improvement in operational design and fulfillment workflows.
About Lief G. Goodson
Lief G. Goodson is chief operating officer of Bunch CareSolutions, A Xerox Company, and senior vice president of analytics for workers’ compensation solutions at Xerox. His key areas of focus are analytics and technology, particularly the development of data systems, reporting capabilities and predictive modeling applications. He is currently responsible for strategic planning, innovation and quality assurance in all service areas.
About Xerox
Xerox is helping change the way the world works. By applying our expertise in imaging, business process, analytics, automation and user-centric insights, we engineer the flow of work to provide greater productivity, efficiency and personalization.