eTransactions saw usage upswing in 2018: report

• The healthcare industry started to show real momentum in electronic administrative transactions in 2018, after several years of more modest gains, according to the Council for Affordable Quality Healthcare’s (CAQH) latest progress report.
• Strides were made in adoption of electronic transactions, cuts in the numbers of manual transactions and reductions in the remaining savings opportunity.
• Still, more is needed to shift the healthcare system from costly, labor-intensive manual transactions to more efficient automated ones, according to the 2018 CAQH Index.

Administrative tasks are a major cause of burnout for doctors and other healthcare professionals. In a new Medscape survey, nearly 44% of U.S. physicians experienced burnout. A major culprit was red tape, such as charting and reporting requirements.

Artificial intelligence and other automated ways of processing routine transactions can do much to alleviate burnout, while increasing efficiencies and cutting costs.

CAQH tracks adoption of HIPAA-mandated and other electronic administrative transactions for doing business between providers and payers, and publishes an annual progress report. The index benchmarks progress in both medical and dental transactions according to seven metrics: eligibility and benefit verification, prior authorization, claim submission, coordination of benefits/crossover claim, claim status inquiry, claim payment and remittance advice.

In the medical industry, adoptions of electronic eligibility and benefit verifications rose 8% to 85% last year. Prior authorizations increased by 4% year over year to 12%, but were still below 2016’s peak of 18%.

Progress in the dental industry was more measured and mixed, with modest gains in claims submissions and payments. Both industries saw 8% declines in adoption of certain transactions — electronic claim remittance advice in medical and electronic eligibility and benefit verification in dental.

Total volume of electronic transactions in the medical industry grew 18% in 2018, according to the report. During the same time, manual transactions dropped by 6% for payers and 1% for providers.

The higher transaction volume led to a $1.3 billion drop in savings opportunity to $9.8 billion last year. CAQH called the findings overall “positive,” but said the healthcare industry could save an additional $12.4 billion a year if electronic administrative transactions were fully adopted. In both medical and dental, the bulk of the savings opportunity is with providers.

Understanding the administrative workflow’s true costs is key to boosting efficiencies and staff productivity. According to the report, the medical industry could save up to $27 per patient encounter requiring all six of the tracked transactions by going fully automated. The biggest savings opportunities are in claim status inquiries, prior authorizations and eligibility and benefit verification, which alone represents 40% of potential savings.

To move the ball further will require “visionary leadership and collaboration” among all industry stakeholders, the report says. “For example, as value-based payment models mature, it will be critical for administrative systems to advance to combine and transact administrative and clinical data elements.”

Also needed are standards and uniform procedures to support development and adoption of electronic transaction technologies.