Although one of the goals of coding is streamlining the claims process, coding errors can lead to delays in the claims process, which can kick of a daisy-chain of consequences that can significantly and negatively impact public health. Delays in the claims process are costly to the payer. They also lengthen the payment cycle for providers and create cash flow issues for patients, creating economic hardship for all. Here’s how that might work in a given situation:
→Denials
When delays turn into denials, costly appeals by the patient and/or the provider may follow.
→Patient Default
Denials can lead to patient default on medical bills. During 2016, more than 66% of patients defaulted on bills of $500 or less. By 2020, that number could increase to 95%.
→Increased Administrative Expenses
Patient default can lead to costly collection efforts. A large portion of provider administrative expenses can be attributed to provider collection efforts, according to Suresh Yannamani, Exela’s president.
→Increased Prices
One of many reasons healthcare providers charge as much as they do is to cover the cost of patient defaults and uninsured patients. What’s the alternative? Going out of business altogether?
→Physician Burnout
“Physician burnout” is now a diagnosable illness caused by excessive workloads and administrative burdens, which are exacerbated by SNAFUs in the claims process.
→Diminished Access to Quality Care
Physician burnout leads to physicians exiting the provider space, ultimately diminishing patient access. It also interferes with physicians providing the highest quality of care.
→Erosion of public health
Diminished access to healthcare is known to directly negatively impact public health. For example, it’s associated with poor management of chronic disease, increased incidence of preventable diseases, and premature death.
Of course, coding errors can’t be singularly blamed for all of healthcare’s woes. As discussed earlier, it’s just one of many examples of the way effective healthcare information management has become pivotal to public health.[In our next post, we’ll be exploring how to get started with your health information management program.Can’t wait? Check out the full story in our Q4 Edition of PluggedIN: Tell Us Where It Hurts:How Tech Can Heal Healthcare.
Sources:
- https://www.cnbc.com/2017/06/26/two-in-three-patients-cant-pay-off-their-hospital-bills.html
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262585/
- https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html
- https://www.alleghenycounty.us/uploadedFiles/Allegheny_Home/Health_Department/Resources/Data_and_Reporting/Chronic_Disease_Epidemiology/HEB-ACCESS.pdf
- https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
