Technology for the Win… Again

Let’s see a show of hands, how many people have manually posted payments for a 10-page Medicare EOB? I have and let me tell you, it is tedious and filled with opportunities for error. The good news is that most folks back in 1995 – when I was entering each payment, adjustment, and transfer by hand – were going to be transitioning to processing 835 Remittance Files in short order. This type of technology would impact medical billing departments in HUGE ways.

Leaning towards the positive is how I roll, so we will start there:

  • Efficiency – A 10-page EOB could be posted in a matter of minutes versus well over an hour. Keep in mind that the biller could be working on other things while this automatically worked away.
  • Accuracy and Consistency – These areas saw significant improvements. The rules were set up in advance and the tools adhered to those rules. No human emotion or decision-making was needed.
  • Speed – Remittance files are now received the day the claim is adjudicated rather than waiting for the mail to arrive.

With change often comes resistance to that change. My dad used to say “no one likes change except a baby with a wet diaper.” Some of the perceived negatives were:

  • Loss of control – How will a system process payment and make these very educated decisions that I make?
  • Job insecurity – Will I still bring enough value to our organization if this type of technology can do my job?

Over the years I have talked with billing department members that were initially resistant to using remittance files and now don’t know what they would do without them.  It took time for them to trust the technology and realize that there was still a role for them to play. The technology simply augmented their ability and freed them to perform other tasks. A billing department’s job is never done.

Five years ago, today, I started my journey as an Opargo employee. We call ourselves Opargonauts. ‘Naut’ is Greek for sailor and I quickly learned that we were sailing into uncharted territory. The last five years have been spent educating healthcare professionals that Opargo can consume the goals of their practice and promote them at the time of scheduling.

For the last 20 years, we – as an industry – have ignored process improvement for the front line in ambulatory settings. Appointment scheduling is viewed as “good enough” with manual processes to understand practice goals and provider preferences. When someone says “our scheduling is fine” I just shake my head and then ask “how do you know that?” These antiquated scheduling workflows make posting an EOB manually look efficient! Very few scheduling departments have much in the way of accountability.

When discussing the idea of using Opargo’s predictive analytics to drive decision-making whilst scheduling appointments, the parallels between the pros and cons to processing ERA files are remarkable.

Scheduling with Opargo, and using predictive analytics / artificial intelligence sees the same accuracy, efficiency, and speed that ERA files experienced, PLUS holds appointment slots for patients who need care the most. Inversely, the perceived negatives are also similar; concerns around loss of control and not trusting the system to do the job that needs to be done surface regularly. Don’t worry friends, just like with remit files, the technology can be trusted and is highly configurable. It will take time, but we will win over the naysayers, one successfully scheduled appointment at a time. As a bonus, the scheduling staff will see improvements in their new more peaceful work environment. The serenity comes from less emotion being used to make scheduling decisions, which is then accompanied by less yelling. Believe it or not, schedulers get yelled at regularly.

The good news is that executive leadership of well-run healthcare organizations understand the power of big data. They know that we cannot continue to schedule patients in a first come first serve environment. And yes, schedulers can now appreciate the efficiency and quality patient care that combining AI with patient scheduling can deliver.

We can do better and we are!

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