Healthcare EDI (Electronic Data Interchange) has been used for decades. Payers use healthcare EDI to determine healthcare coverage and verify benefits. EDI is as important as several other data exchange formats in the healthcare industry. Healthcare EDI has transformed the healthcare industry, manufacturing, and supply chain.
So what is healthcare EDI?
Healthcare EDI is a way for healthcare organizations to exchange data to and from external systems and entities. Instead of preparing such data manually and risking errors in data, and possible data theft, electronically preparing and transmitting data and electronic data interchange avoids such problems. As an output, healthcare industries can automate their healthcare processing systems, including patient care systems.
How is healthcare EDI related to HIPAA compliance?
Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a law or mandate protecting patient data. Any disclosure or sharing of sensitive patient data must be with the patient’s consent as per electronic data interchange in healthcare laws. HIPAA also requires healthcare organizations to follow a data format to transmit and process healthcare data. Standardized data is consistent, and data anomalies can be avoided.
The law also requires healthcare companies to use secure encrypted electronic transmission, access health data, and implement automated compliance checks for regulations related to HHS privacy. Before the widespread implementation and adoption of HIPAA, healthcare organizations used their proprietary codes for medical electronic data interchange. This made it difficult to exchange data, and any pre-processing of data was expensive.
Why is EDI in healthcare important?
Healthcare EDI is important because it improves the productivity of healthcare operations. It reduces anomalies, enhances data accuracy, processing efficiency, and healthcare delivery speed. There is limited or no human intervention. So the scope of malpractices or compromising data security is low or none.
In addition to helping streamline the entire process lifecycle of filing out claims and submitting them, software for medical coding and billing allows providers to track each of the claims submitted. This is yet another tedious, manual task that non-medical staff at hospitals and clinics need to put up with. It’s no secret that claims could take days to get approved for providers to get reimbursed. So, medical coding systems that also include billing and claims tracking features would help...
Remote Patient Monitoring Can Be a Game-Changer for Healthcare
As the name indicates, remote patient monitoring (RPM) involves the use of technology to monitor patients’ health and vital signs outside clinical settings. It has shown enormous potential to improve accessibility to care and address many inequities. Although the idea behind RPM was conceived over a decade ago, the Covid-19 pandemic pushed many providers as well as patients to re-think their stance on RPM.
Innovations in health information gathering form the cornerstone of...
Things to Look Out For When Investing in a Hospital Management System
The larger a hospital gets, the more the number of services it is likely to offer. It invariably means more medical staff, more administrative staff, a greater volume of patients, more data, and more management burden. A hospital management that is at least moderately large is bound to have its testing and imaging facilities, the results of which need to be compiled appropriately.
Is Revenue Cycle Management Software A Mandate For Healthcare Providers?
Revenue cycle management is a two-way process offering providers with seamless reimbursements and patients prompt care. It is eminent for any healthcare entity and should be streamlined using the best digital tools of the technical world.
What is revenue cycle management?
The process includes conceptualizing a strategy to manage the healthcare revenue cycle clinical and administrative functions. It conjures several terms such as appointments, invalid deductions, billing systems, remote patient care, patient data, and much more when related to healthcare providers. Starting from a single call for the appointment, the cycle revolves around certain steps and concludes when the payments have been closed for the treatment. The main goal of managing revenue is to identify any loopholes in the entire cycle. When done properly, revenue cycle management can help maximize claims and enhance return on investment.
Medical Billing Solutions Boost Revenue Cycles for Providers
The complexity of American healthcare is no secret. It’s part of the reason why it’s as expensive as it is, and why innovative software solutions could help with that problem. In most countries, a patient walks into a hospital for a consultation, the doctor examines him, prescribes tests and medication, the person pays for it, and goes home. If it’s a country with universal healthcare, then government-run hospitals don’t charge any money.
But in...
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American healthcare is extremely complex with many layers of regulation and bureaucracy. From the time a person walks in for a consultation, to the moment when the doctor gets paid for his services, there is an elaborate series of steps that need to be carried out for everything to work out smoothly.
Managing appointments, verifying insurance coverage, documenting the visit, medical coding, and submitting a claim to a payer are the steps of processes that transpire between a scheduled appointment and a doctor getting paid for his services. Needless to say, it is a very long, time-consuming, and laborious process that is also prone to errors. But digitization has alleviated much of the problems that haunt these procedures. Thanks to innovations in healthcare technologies, there are digital solutions from multiple companies for each of the processes mentioned above. However, all of them need to work together seamlessly in order for providers to derive value for their investment in the solutions.
