Inside IT

Tom Hughes

As nearly half of all hospitals plan increases in back-office technology, strategies for choosing the right options can help contain costs and enhance value.

Electronic transactions are receiving increased support as they become more efficient, shifting the paradigm in office spending. Today's providers are spending larger portions of their budgets to upgrade back-office systems to enhance efficiency and improve patient and payer interactivity.

An early 2010 survey of hospital IT executives at small- to mid-sized hospitals found that three-quarters of these organizations planned to increase their IT budgets in 2010-and 45 percent planned to focus on back-office technology (McGee, M.K., "Most Hospitals Increasing IT Spending," Information Week, Jan. 27, 2010). Twenty-six percent of these hospitals planned to invest in data exchange and leveraging systems, and 12 percent planned to improve infrastructure and administrative efficiency.

Providers should employ a number of strategies in selecting back-office technologies that automate, improve, and reduce the operational costs of traditional offline, paper processes. In fact, solutions for processes from charting and record keeping to denials management and attachment submission are capable of reducing operating costs by one-third over their offline counterparts. The challenge lies in identifying and implementing solutions that do more than put a modern gloss on old inefficiencies.

Medical Billing Systems

Perhaps the oldest, most accepted form of automation in the medical back office is the medical billing system, which offers opportunities to improve the effectiveness of both the payer and provider office environment. The problem is that many offices adopt a software solution and force their employees and internal process to fit the solution. This is not the best way to leverage the power of electronic or virtualized processes in any office. And as medical and billing software become more complex (to meet the demands of more complex billing and paying solutions), exposure to risk increases: Providers run the risks of accidental overcharging, erroneous claims, and improper formatting, and payers face the risks of accidental over- or underpayment, erroneous denials, and improper receipt or storage of claims, attachments, or payments.

So what are the hallmarks of a system that works? How do you choose a software solution that eliminates duplicated work errors and other complications? Here are three tips.

Be wary of proprietary software solutions. Proprietary systems often come with licenses that will not allow providers to customize the solution to meet office needs, resulting in wasted time throughout the life cycle of the system.

Make sure the solution is easy to use. Many offices adopt software solutions that are difficult to use and require many hours of training before, during, and after deployment. The most robust and easiest-to-use solutions allow users to select procedures and diagnostic codes from a drop down list or similar interface. Strong solutions provide automated solutions to late payments and debt collections.

Team with a company that has a proven proficiency in your specific area. For payers, this recommendation means selecting a software solution that has been implemented in similar situations. For providers, it means selecting a software solution that can handle the specific needs of a particular field of health care, such as anesthesia and cardiology. For both payers and providers, it means asking the vendor for white papers, case studies, and references.

Electronic Records and Claims Technologies

The benefits of electronic charts and claims abound, including the following:

  • Lower operational and resource costs for paper, filing, ink, and more
  • Increased cash flow cycles
  • Reduced storage and maintenance costs
  • Labor reductions
  • Increased security

Finding a high-quality electronic records vendor takes time. Consider the following approaches.

Identify your organization's needs and plans for project growth. It is vital that providers and payers know their storage needs, as well as projections and plans for growth over one-year, three-year, and five-year periods.

Ask to see the technologies in action. This will make it easier to plan for and implement these technologies.

Triple check for compliance with the Health Insurance Portability and Accountability Act. Also, make sure the solution will be updated not only with convenience features, but also with bug fixes and regulatory updates.

Electronic Attachments Solutions

Electronic attachments in the hospital setting are relatively unheard of, despite their proven efficacy in the dental industry. In fact, many organizations that have adopted electronic records still process, store, and mail paper attachments. Electronic attachments are a powerful way to streamline both payer and provider office processes and to reduce expenses-and they often cost as little as two-thirds the cost of processing and filing paper attachments.

The following are strategies to consider in choosing electronic attachment technology.

Ensure that the tool complies with government regulations. The government will be mandating changes to attachment formatting soon. Comply with regulations now to avoid confusion later, and ensure that the vendor will provide regulatory updates when legislation and regulation are passed.

Choose a solution that verifies receipt of attachments automatically. Having this capability will increase customer satisfaction, as customers' top complaints include lost attachments and long payment cycles. With the right technology, providers can provide information to payers quickly and accurately, resulting in more timely payment. Meanwhile, payers can increase their EDI claims submission rates.

Check that the solution includes attachment storage and databasing for potential audits and future reference. These features will eliminate the need to reprocess and resend attachments.

Getting the Most Value

Smart provider organizations will leverage electronic payment systems, charting solutions, and attachment technology to maximize the effectiveness of their back-office operations. Take the time to ask the right questions-of both the vendor candidates and your physicians-to ensure that your organization invests in the solution that best meets your back-office needs, now and in the future.

Tom Hughes is CEO and president, Medical Electronic Attachments, Inc. (MEA), Atlanta ( 

Publication Date: Friday, April 01, 2011

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