Electronic claims submission could save $11B per year

Right now, 25 percent of physician claims are submitted on paper each year. That's a whopping 3 billion claims still being handled the old-fashioned way. The vast majority of those claims are being filed by small provider offices with one to five physicians. Meanwhile, a full 90 percent of payments to providers come in the form of paper checks rather than electronic transfers.

The healthcare industry simply can't allow things to stay this way, argues MD On-Line CEO Bill Bartzak, who spoke at last week's session of the World Health Care Innovation and Technology Congress in Alexandria, Va.

Bartzak's company offers practices free access to a Web-based system offering batch claim processing for those with practice management software; another web-based option for practices without practice management software; patient eligibility verification; patient statements and electronic claims payment information.

Offering such tools to lagging practices is critical, Bartzak said. Converting these remaining paper claims to digital form could save $11 billion per year, and full use of EDI technology could save $86 billion per year, he told the audience.

According to Bartzak, it doesn't make sense to focus on more advanced electronic data exchange options until you address the physicians who aren't on board. "[Much of the industry] may be at phase III in this process, but the doctors we're trying to get out of paper are in phase I," Bartzak told the session attendees. "Under five-person practices are the biggest culprits."

Along with some other competitors, Bartzak has started working with payers to streamline their claims and electronic payment processes. One of his clients is giant health plan WellPoint, which has been working to convert paper submitters to electronic claims.
Over the last 12 months, WellPoint has been able to convert more than 550,000 claims, that would otherwise have been on paper, to digital submissions. Last month alone, nearly 110,000 newly-digital claims were submitted by more than 5,000 practices.

To foster this kind of change across the industry, however, it may require getting tough, Bartzak argues. For example, he's in favor of a 2007 directive issued by the state of Minnesota requiring health plans and providers to file claims electronically. "Electronic claims are not an opportunity, they're a necessity," he says. "It's time to draw a line in the sand."

To learn more about MD-Online:
- visit the company's site