Blogs

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.

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.

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:

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.  

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.  

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.

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.