Healthcare industry consists of multiple stakeholders. There are providers, Billing companies / intermediaries, TPAs, and Payors. Healthcare industry is inundated by thousands of Practice, Hospital, Billing & Payor management and other IT systems catering to various needs.
Majority of these systems are “On-premise” legacy ones, some of which may not have any more support for upgrades or extensions from the vendors. Healthcare service providers have invested heavily into proprietary middle ware or customized APIs to make data flow across these heterogeneous systems. The disparate islands of systems need manpower for data entry, upload and download and experience data duplication at multiple levels. Obtaining real-time & accurate flow of information, quickly responding to the patient request and comply with complex regulations are challenges faced by the industry.
Let’s us look a hypothetical example to understand the challenges and how a smart integration would benefit healthcare providers. Apollo is a multi-specialty hospital chain with a combined bed strength of about 2000 beds across the US. Apollo’s aggressive growth has been a result of both organic and acquisitions. Apollo uses a best in class Hospital management platform across its branches to manage administrative & patient workflows. However, due to acquisitions, not all hospitals use the same platform. Some continue to use the pre-acquisition system reasons including contractual obligations, license costs, ease of use, specialty focus, etc. Apollo does not manage its billing services. They have outsourced to a professional Billing & Revenue Cycle Management company who use their proprietary Billing Management System (BMS). Currently, data captured in the HMS need to be recaptured into the BMS manually for the RCM process to proceed. There is a high probability of inaccurate data entering RCM applications with a downstream effect on revenue realization. TPA’s and Payors working with Apollo have their own applications for claims processing which are not integrated with HMS. There is a large team just to capture & manage data between different applications. Being a manual process, it is error-prone, and not real-time and hence impacts the speed of claims submission and resolutions.
In this context, it is very important to seek out a solution that enables extended use of existing IT investments but also seamlessly allows data transmission in a more integrated manner. The solution should also be able to move data in real-time and accurately between the various applications. Exdion Smart Gate (ExdionSG) is a solution providing for a seamless integration of multiple applications in the Healthcare claims administrative life cycle providing for improved quality & revenue. The solution is bespoke and hence highly customizable catering to the needs of Hospitals and their varied environments. With ExdionSG service providers can bring down claims administration costs while improving on revenue generation time frames. ExdionSG will not only improve overall quality, productivity, and turnaround times but also reduce the dependency on manual efforts.
ExdionSG enables real-time data transfer between the different HMSs of Apollo, BMS & Payor systems. The entire manual component of re-entering/capturing data repeatedly in multiple applications/levels in the life cycle is eliminated. This leads to quicker & more accurate processing of claims resulting in better revenue realization. It is estimated that ExdionSG can save 30% on people costs up to 30% and increase the revenue realization up to 10%.