Operational inefficiencies are the leading cause of waste
One out of every three dollars spent on healthcare each year is spent on the repetitive, high-volume tasks that make up the administrative side of healthcare. Increasing regulatory requirements are only adding to the burden – an American Hospital Association study
found that an average size hospital today dedicates 59 full time employees to regulatory compliance alone, over a quarter of which are clinical staff.
Interacting with health insurance plans is also puts pressure on a hospital’s time and resources – from authorizations, formularies, claims and billing, credentialing, contracting, and data quality review, the process is time-consuming and requires many manual steps that are prone to costly errors. Today, flaws in registration and eligibility processes are cited as the primary cause of insurance claim denials – an analysis
found that $262 billion of the estimated $3 trillion in claims
were initially denied due to errors, translating to an average hospital risking $4.9 million of lost revenues.
As operational inefficiencies continue to drain valuable resources, it’s easy to see that the never-ending flux of data entry comes at cost – an even bigger cost when you consider the expense of re-work.
At the heart of these process inefficiencies is the lack of interoperability between systems. Data has to be manually pulled and entered from one screen to another, over and over again, making human error inevitable. And with increasingly complex regulatory needs and requirements, an overhaul of the entire system is far-fetched. Hospitals need solutions that work with
the systems and processes they already have in place – and this is where organizations have a tremendous opportunity to create financial impact with artificial intelligence.