Not only do healthcare organizations have to be concerned with providing quality patient care, poor documentation is another factor that can have a serious impact on healthcare organizations. Healthcare providers are required to retain their Explanation of Benefits (EOBs) for seven years, which can pose quite a challenge. The lack of complete documentation in patient medical records can result in errors in reimbursement, financial planning statistics, and clinical data. The goal of documentation is to provide sufficient and accurate clinical data for correct coding and billing for all services provided to the patient. Missing or incomplete documentation can lead to unbilled or denied charges, which leads to significant lost revenue.

Often many of these statements are between one and several hundred pages long and all need to be reviewed closely to ensure billings are accurate and your services are being paid. With a retention period of seven years, healthcare providers need to be sure they have the right system in place to protect these documents from being lost or destroyed. Often, these providers are turning to online EOB retention systems that can protect information, organize information for easy access, and archive important documents for compliance. An integrated classification and data extraction technology for EOB document management typically has a records management capability that can capture an EOB electronically and automatically set it to be retained for its required period.

Through the use of integrated classification and data extraction technology, healthcare providers can improve the way they do business and actually save on costs. As the Department of Health and Human Services' regulations have strict requirements when it comes to EOB compliance, it's important to make sure your system for compliance is secure.

Healthcare organizations manage hundreds, perhaps thousands, of documents each day — all of which contain data that needs to be entered into an ECM (enterprise content management), ERP (enterprise resource planning), or financial back-end system. Before the processing of these documents can be completed, however, staff sorts them by their document type and records essential data. This manual effort can take hours to perform, creating a bottleneck in productivity and a opportunity for human error.

Today, IT teams are able to use integrated classification and data extraction technology to ease identification, sorting, and data determination challenges. Data classification, tightly integrated with data extraction, works with a scanned image of an EOB to automatically capture all the patient claim data while allowing an organization to retain full control of their data and documents in-house, from envelope to archive.

Additional labor savings are obtained by automatically validating captured data and balancing procedure charges, claim totals, and EOB totals to ensure accuracy so that only discrepancies are routed to human review. IT staff also try to ensure that line items can be automatically verified within a claim by matching the items within an original claim in the patient accounting system. Once matched, accurate data and images are delivered to patient accounting, financial management and other business systems.

Classification and extraction technology is used to identify questionable data and characters and flag them for review and quick resolution. It can also verify EOB line items against corresponding claim data in a patient accounting system. This technology can automatically processes both the high-volume of EOBs from the payers and claims that are filed on a regular basis, as well as those less frequently filed. Today, this technology helps automate data capture and processing for all EOBs.

HIPAA compliance is key for healthcare organizations to meet federal guidelines on patient privacy. Hospitals, clinics, and healthcare providers are transforming the way that they collect and manage medical data. Regulations like HIPAA have demanded new standards and legislation is encouraging the adoption of not only records management solutions but also the way classification and extraction technology manages patient data. This is, in part, because the classification and extraction system can create snippet image files that contain all the claim data supplied on an EOB for a single patient claim.

EOB header and footer information is also included for context and reference and typically includes payer name, EOB issue date, check information, and explanations for reason and denial codes. With an image isolated to a single patient claim, claim data can be forwarded without having to black out or cover private information regarding other patients.

Typically, data classification and extraction technology enables the automatic extraction of EOB data fields (such as patient name or account number) to serve as index fields in patient accounting or document management systems for quick retrieval of EOB data, individual patient image snippets, or entire EOB images. With this technology, there is a significant decrease in manual entry costs and an increase in summary data accuracy and line item details, such as procedure charges and diagnostic codes. From a healthcare IT perspective, IT staff will use the technology to create individual patient record snippet images to aid in HIPAA compliance as well as automatically index EOB data and images for quick retrieval.

DAVID ROCK, President and CEO of NovoDynamics, specializes in advanced document capture, optical character recognition, document image enhancement, data classification, and predictive modeling solutions across healthcare, government and a variety of business segments.


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