In recent years, many physicians have grappled with the decisions of handing over their practices to hospital chains or medical groups to alleviate the burdens of billing complications and confrontations with insurance companies. While this point is cited as the overall reason, some experts believe that the solution to these issues instead lies in the use of big data to reduce the number of inaccurate insurance claims filed, as well as potentially increase the revenue of their practice. A recent press release published by PR Newswire through Markets Insider cites the expertise of Dr. Karun Philip, Tranquilmoney president, and co-founder. In this, Dr. Phillip offers this alternative point of how big data could alleviate additional issues and even provide beneficial solutions to these practices overall.
Reducing Fraud, Claim Denials, and Overall Costs
Because fraud or suspected fraud cause a significant amount of healthcare claim denials due to unnecessary procedures or inaccurate billing, fraud has now become a significant cost of our nation’s healthcare payers. These forms of fraud, in addition to denied claims as well as unintentional fraud, can cause major damage to private practices, with medical claim denials among the most costly to sound practices.
Embracing Big Data
According to Dr. Philip, the embracing of big data by the healthcare industry will overall reduce healthcare fraud while also reducing costs by lowering physician claim denials. These reduced costs may even come along with better care and increased profits for medical practices. Dr. Phillip also suggests the way in which big data analytics can detect patterns in data that may otherwise lead to various insurance claim rejections, adding the way in which it “helps providers submit accurate claims as often as possible, allowing the reduced number of manual interventions to be more productive.”
Better Processes, Better Results for Patients
With this, Dr. Philip also adds that big data may also lead to a more straightforward and more accurate billing process for healthcare providers. For providers who may not be as equipped with the necessary technology may also be lacking data needed for treating patients. This use of big data may also streamline processes by showing providers which medical procedures are required, in addition to insights on past patient procedures for a more accurate claim. With the efforts of big data geared towards to minimizing medical errors and eliminating issues surrounding repeat medical tests or procedures, its success may point to more benefits than threats. In addition to fewer claim rejections, the industry may also find benefits such as revenue cycle management, which in turn will allow doctors to improve their practice with better decisions supported by hard data.
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