Non-profits and healthcare providers often find themselves in a tight spot. They need to manage the needs of their clients while also protecting those clients’ privacy. In addition, federal and local laws often constrain how freely a provider can share information, whether that’s with another healthcare institution, an insurance company, or the state.
Every time someone gets medical care, the healthcare provider will assign their diagnosis a billing code, which they then attach to a claim submitted to the patient’s insurance carrier. The carrier then determines whether or not they’re going to cover the expense—depending on the coverage plan, they may cover all, some, or none of the service—and the patient is sent a bill for any remainder. This process is often long and complicated, requiring numerous overlapping functions. Is there a more efficient way to handle to process?
HIPPA Constraints
The Healthcare Portability and Accountability Act or HIPPA, as it’s more commonly known, was passed by Congress in 1996, designed to modernize the flow of health insurance information while protecting patients’ privacy. HIPPA compels all but minor healthcare providers to submit insurance and billing claims electronically and prohibits sharing medical information without the patients’ explicit consent.
Naturally, this presents both a security issue and a communications issue. Providers must know how to protect their patients’ info when sending their billing codes and diagnostic information to insurance companies.
Fortunately, AI can address many of these difficulties. For example, C3S’s HIPPA-compliant platform enables healthcare providers, insurance companies, and government offices to share information securely and privately. Moreover, it allows all of these institutions to communicate with patients, replacing huge filing cabinets of paper files with a centralized digital platform capable of securely storing many different documents. Finally, patients and healthcare providers can communicate via a single channel. That way, if healthcare providers from various institutions need to coordinate care, they can directly solicit a patient for permission to share information, rather than waiting for them to respond via snail mail or through a fragmented network of competing electronic portals.
AI and Claims Submission
There are numerous benefits to centralizing billing and claims submission. First, it’s more efficient and less costly than submitting manual documents, which can be laborious and time consuming, or relying on separate systems for different submissions. Secondly, an electronic system like C3S has safeguards to ensure that all necessary information is included on a claims form or billing statement. The AI can flag a field that’s either empty or improperly filled out, which prevents clerical errors and misinformation. Finally, it can also be used to track the progress of claim submission and the status of a payer’s account, giving instant updates when a payer processes a payment. Give C3S a call today if you’re interested in learning more.
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