Submitted by Brian Spraetz on Wed, 06/19/2013 - 11:12
The Congressional Budget Office estimates that 27 million uninsured will gain coverage under the Affordable Care Act. As memberships begin to swell in 2014, health insurance payers must confront a simple fact. More members mean more claims to process. Auto adjudication rates are pretty much maxed out. Manual claims operations are already stressed to their limits. Payers need to plan now how to handle the coming increase in claims.
Submitted by Brian Spraetz on Wed, 06/05/2013 - 14:29
The switch to ICD-10 codes coming in October 2014 is expected to cause significant increases in manual claims processing workloads. Just like a perfect storm, this claims surge from ICD-10 implementation will be driven from a powerful confluence of factors. Sharp increases in coding errors, denials, and adjustments for example. To make matters even worse, productivity is expected to dip as processors and coders work to gain familiarity with the completely new and greatly expanded code set.
Submitted by Dan Enthoven on Tue, 06/04/2013 - 15:19
Healthcare claims payers know that accuracy is critical. Underpayments cause complaints and rework. Overpayments may never be caught. The Enkata employees performance optimization solution helps claims payers achieve substantial accuracy gains in the following ways:
Submitted by Brian Spraetz on Mon, 06/03/2013 - 12:15
The cost of manual claims processing operations is top of mind for healthcare payer organizations. A survey from HealthEdge found that health insurance executives cited “High rates of manual processing/need to reduce administrative costs” as a top concern when asked to rank significant obstacles facing their organization. 30% of executives ranked it as their highest concern, and nearly two thirds ranked it as a one of their top two priorities.
Submitted by Dan Enthoven on Thu, 05/30/2013 - 11:20
The more we look at the data Enkata produces, the more it becomes clear that claims payers need Enkata if they want to make substantial quality and productivity gains in their manual claims paying operations. There are many ways claims payers can improve their processes, but all of the largest potential improvements come specifically from understanding how people work.
Submitted by Dan Enthoven on Tue, 05/28/2013 - 12:15
As Enkata analyzes workforce performance, we continue to find areas where conventional wisdom is overturned by real data. We recently concluded a study of more than 14,000 work days to see how employees work, looking at differences between office and home based workers. Here are three surprising differences between remote workers and those that come into the office.
Submitted by Dan Enthoven on Wed, 05/22/2013 - 12:02
Companies are turning to all sorts of new ideas to track what their employees are doing, or not doing, all day. Some of these can seem pretty strange. For example, Tesco is in hot water for putting electronic armbands on their employees. This way, it can track where they are in the warehouse, how fast they’re walking, and even how long they spend in the bathroom. Invasive? That’s nothing.
Submitted by Enkata on Wed, 05/29/2013 - 15:43
Organizations with a strategy for streamlining processes and reducing administrative expenses will gain a competitive edge over those that do not.
Submitted by Enkata on Tue, 05/21/2013 - 12:21
The health care industry is facing many radical changes in the coming months, and those changes are having a significant impact on how processors and claims offices do their jobs. Claims processing teams must overcome these five challenges in order to successfully navigate these coming changes.
Submitted by Dan Enthoven on Tue, 05/21/2013 - 11:26
Managers love metrics. Numbers are easy to see, compare and understand. Objectives based on numbers can be tracked in a way that soft objectives can’t be. When the numbers are good, everything is fine. Or not.
Just as metrics can be revealing, they can also be used to hide real problems. Companies that focus on high level metrics are frequently missing the greater opportunity for improvement.
There are three problems with managing to metrics only.