Providers Need More Than a Clearinghouse to Compete

Advances in technology in all areas of life happen at a furious pace. Smartphones and smart homes are the norm.

09.06.2017
One place where technology seems to advance more slowly is the provider’s back office. Claims, denials and patient eligibility continue to be submitted “manually,” although automation technology exists.

Provider offices submitted 119 million claims manually in 2012, compared to 1.1 billion submitted electronically. In 2015, 95 percent of providers and health plans submitted claims electronically. Nevertheless, the remaining 5 percent is a significant number of manually submitted claims.

It’s becoming increasingly difficult to compete in healthcare if the provider’s back office isn’t fully automated. A modern clearinghouse function has evolved, just like other technologies, to become much more than it once was. Today, revenue cycle management (RCM) combines multiple areas related to the practice.

Providers may shy away from RCM operations because they are not a core competency. They’ve trained to be the best at treating patients; they haven’t trained to be the best at submitting claims.

Working with a highly skilled RCM partner ensures providers use the most up-to-date technology, have direct access to thousands of payers and utilize best practices across the board for any revenue cycle related task. The partner keeps track of trends and changes in reimbursement, denials management and patient financial information, freeing up the provider to care for patients. In addition, the partner can easily and economically scale the solution as the practice grows.
 
Kevin Lathrop is President of TriZetto Provider Solutions, a Cognizant Company. He works closely with the operations, product management and development groups to ensure TPS delivers superior, highly effective revenue cycle management solutions to our customers in multiple healthcare settings. TPS is one of the nation’s largest revenue cycle management organizations, offering patient access, claims and denial management, contract management and patient financial solutions. 
 

TriZetto Provider Solutions® Powered by Cognizant

We help physicians, hospitals and health systems simplify business processes and get accurate payments quickly. We will always look for new ways to help you improve revenue and increase cash flow. We will stay ahead of regulatory changes so your office will never struggle to keep up. All so you can focus on the one thing that really matters: doing what is best for your patients.

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