Leveraging IDP eliminates confusion and delays associated with processing EoBs by hand, including fewer keying errors, accurate coding, clear access to relevant data, and rapid organization/integration with core systems.
Improving patient care
Great patient care goes beyond bedside manners, but payment denials and delays to services rendered is frustrating to providers, stressful for patients, and risky for payers. The problem often lies in a lapse of communication between patients, payers, and providers that could stem from an unclear view of what is owed, and who is to pay.
Delivering transparent patient data is essential. Unfortunately, common EoB processing pain points can leave patients with surprise bills, unknown payments, or incorrectly stated information.
EoB processing pain points include
- Manual processing effects like misclassifications, slow processing, or employee burnout.
- Disjointed or siloed systems. (i.e. EoBs not able to flow into an EHR)
- Essential data trapped in static files or multiple files
- Inconsistent terminology or formatting
Lost in translation
A recent study on patient expectations marks that 79% of patients with denied claims blame a difficulty in understanding their coverage, with 50% of folks not understanding their explanation of benefits (EoBs).
When patients don’t understand their EoB, or receive bills in advance of their EoB, it creates a ripple effect across the entire payment cycle including:
- Delayed Payments – Unclear cost breakdowns lead to confusion, prompting patients to delay payments while seeking clarification.
- Increased Call Volumes – Patients overwhelmed by jargon and unclear denial codes can flood provider and payer hotlines, adding to workloads and stress.
- Appeal and Claim Reprocessing Delays – If patients don’t recognize or act on a denied claim, they may miss appeal deadlines, leading to lost revenue or a prolonged revenue cycle.
Patients aren’t the only ones
In an ideal world, automated optical character recognition (OCR) data capture and extraction technology would be able to transform a process like EoBs by reducing manual inputs, extracting key codes and insurance information, and integrating EoBs into EHRs.
However, in the same way patients can find it profoundly challenging to understand information on an EoB, so too have the past iterations of capture technology.
Due to the widely varying formats that insurers might structure an EoB in, the uniqueness of services, and the complexity of data, EoBs have proven to be notoriously difficult to process.
Until now.
New capabilities bring new possibilities
Team KeyMark has been hard at work to bring an advanced wave of AI and machine learning capabilities under the hood of our CloudCapture capture as a service system, built with EoBs specifically in mind. This combination of AI and data capture significantly outperforms previous OCR engines in a few key ways:
- Structural IQ - Traditional OCR often struggled with complex or multi-line data structures – common in EoBs. Improved intelligent capture recognizes and understands complex data structures and processes them accurately despite variations.
- Natural language processing - Past OCR systems looked at individual characters. Intelligent capture processes and understands complete words to process the full context of data and helps to better distinguish between data points.
- Reduced training – With so many different formats for EoBs, and OCR models requiring hundreds of training documents to produce accurate results, training models was incredibly time intensive and burdensome. Today’s systems can now train complete models with tens of documents and can make much better predictions on data even on a first encounter for near zero-shot learning.
Intelligent Capture feeds IDP solutions
With everyone (including KeyMark) harping on these “AI advancements”, it’s easy to get some wires crossed. Intelligent capture is just the first step in a larger solution of complete data/content understanding for EoBs called intelligent document processing (IDP).
IDP carries captured data through a multistep process that can occur in seconds, and consists of document classification, validation, context understanding, and routing/integration into key systems. In the case of EoBs, that means straight-through processing to an EHR.
The value of transformation and transparency
Leveraging IDP for EoBs eliminates a lot of the confusion and delays associated with processing each EoB by hand including fewer keying errors, accurate coding, clear access to relevant data, and rapid organization/integration with core systems. All that comes with some substantial benefits to patients, payers, and providers alike.
- Patients understanding their costs upfront pay on time, improving providers’ cash flow and reducing collection efforts.
- Patients with faster access to their EoBs quickly identify and challenge incorrect charges to prevent financial burdens.
- Providers spend less time on paperwork, and more time on patient care.
- Fewer resources are spent processing and correcting EoBs.
- Improved payer to patient relations.
Start processing EOBs
We’re incredibly excited to have cracked the case on how to process EOBs for the benefit of our partners in healthcare and insurance. Get in touch with us to start your project or learn more about KeyMark’s intelligent document processing service for EOB, CloudCapture!
