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Provider Data Exchange: Why Digital Dominates


If your practice is still using paper-based fax or combining traditional and digital fax communications, you are not alone, but you are behind.

If your practice is still using paper-based fax or combining traditional and digital fax communications, you are not alone, but you are behind. According to a study by CAQH CORE, only 6% of medical document attachments process using a fully electronic method, despite the ever-apparent limitations of analog fax in the areas of reliability, speed, and security. According to the study, industrywide per-transaction, we will see a 60% reduction if all health care paperwork is processed electronically.

Amid the shift toward value-based care reimbursements in health care, the physician must leverage efficiencies in all practice areas, mainly administrative operations. Managing document transfer via cloud-based technologies helps practices streamline their information processing and exchange workflows to attain clinical and financial successes. In addition, the COVID-19 pandemic further reinforced the need for adaptable work environments enabled by remote employee access and digitized document processing workflow.

The need for effective information transfer

In providing timely, effective care to patients, physicians require the ability to share patient clinical documentation with payers and other providers digitally. Unfortunately, health care document exchange is currently largely manual, error-prone, and plagued by methods that do not work. For example, fax is the most common secure communications protocol that providers use to electronically transmit patient documentation, which leaves the recipient with a paper document that is not processed manually. While other methods of information exchange exist, physicians often feel there is no reliable alternative to paper-based faxing due, in part, to their greater comfort level with the technology.

When providers request prior authorizations from payers for necessary services or prescriptions, they must do so within tight turnaround times. Failure to meet request deadlines can result in care delays for patients and denial or reduction in payment to providers.

In short, processing documents takes time and costs money. Those costs are passed on to the patient and physician alike. Manual document errors could also result in difficult coverage decisions when payers lack access to the requisite data points. CAQH CORE illustrates one plan needing 792 labor hours (the equivalent of nearly 20 people working full-time) to process the attachments it receives by mail, fax, and web portal during just one week—an enormous administrative burden.

Digital exchange, physician success in value-based care

Digitizing the exchange and processing of medical documentation with evolved fax and document processing tools delivers numerous benefits to health care stakeholders. For example, payers are improving operational efficiency and handling claims and medical documentation faster. Other benefits include:

1. Automated document classification - doc processing tools can analyze incoming documents to determine their document type. Once the physician identifies the document type, it automatically routes to the right team for processing.

2. Data Extraction - document processing tools locate and extract critical pieces of data from incoming docs (patient name, patient social number, physician name, date of service, NPI, etc.). This data is associated with the document and can integrate into the information systems. By atomically extracting this data, significant time and money will be saved by eliminating manual data entry and document routing. The data also become far more accessible to those accessing it. (Think of data you can search for in application vs. hunting for a piece of information on a scanned document or fax).

Providers are achieving and maintaining clear communication with other care partners, especially when coordinating transitions of care requiring comprehensive and timely transfer of information.

Furthermore, providers leveraging electronic medical attachments make essential strides towards interoperability, breaking down the data silos of disparate clinical and administrative systems. The seamless exchange of clinical documents needed for claims adjudication, prior authorization, and quality measure reporting has also become essential for value-based payment success. It facilitates earlier identification of patient risk factors, reducing the time and effort associated with quality measure reporting and easing the adjudication of value-based payments.

The journey of fax maturation

There are many barriers to the digitized exchange and processing of medical attachments, from the lack of federal standards for data exchange to different workflows within each organization. Still, every organization can take steps to tackle the “paper challenge” by reducing or eliminating paper-based faxes, which require substantial manual intervention to digitize and route them to the appropriate department.

Fortunately, digitizing and streamlining paper-based workflows does not require huge capital investment or an overhaul of existing health IT infrastructure. By swapping their existing fax numbers for a cloud-based digital fax platform, both providers and payers are bidding farewell to traditional fax machines, enabling the move from paper to HIPAA-compliant, secure, point-to-point paths for exchanging data.

Augmenting the digitized information exchange approach with artificial intelligence document automation technology can yield additional benefits. For example, AI and natural language processing can identify and extract crucial information within the document required to process a prior authorization, referral, or any other document type. These data include a patient’s name, medical record number, date of birth, the physician name, NPI, and service date.

Automatically extracting this data decreases the amount of manual indexing necessary to route the document to the correct system or team. By largely automating the process of receiving, reading, classifying, and routing documents, organizations can save time and ensure information is not lost or misfiled but is processed faster by the correct person in the clinical, financial, or administrative department.

Switching to this technology means manual entry, and human error can be reduced significantly or eliminated. In addition, the information in outbound and inbound documents can be prioritized, addressed, processed, and delivered appropriately, speeding clinical and administrative processes.

A seamless 100% digital exchange of patient information is essential as the health care system continues to pursue value-based care. The approach will facilitate fast and accurate decision-making by reducing the costly administrative burden of information exchange for providers and payers.

Christopher Larkin is chief technology officer at Concord Technologies, a cloud-based fax and intelligent document automation software provider for healthcare providers and enterprises.

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