Reduce Healthcare Waste with Credentialing Software

IN A NUTSHELL:

• Healthcare waste includes failure of care team communication
• Paperwork alone costs the industry billions of dollars
• Administrative complexity increases costs for everyone

Healthcare waste plagues the industry and reaches far beyond the disposal of medical supplies, with paperwork alone accounting for billions of dollars annually.

Healthcare administrative costs total more than $250 billion a year, including time and resources devoted to billing and reporting to insurers and public programs.  In fact, the administrative complexity of healthcare system in the United States is the main factor which increases costs for everyone in the market, according to researchers at Stanford University.

Other forms of healthcare waste include:

• Failure of care delivery
• Failure of care coordination
• Failure of pricing
• Healthcare fraud and abuse
• Overtreatment or low-value care

The United States spends more on healthcare than any other country, with costs approaching 18% of the gross domestic product, and studies estimate nearly 30% of healthcare spending may be considered waste, according to the Journal of the American Medical Association.

Researchers highlighted two essential actions which can alleviate healthcare administration costs:

1. Creating uniform rules about the exchange of data and information, especially PHI
2. Using technology and other software instead of manual processes

Outdated, manual processes such as medical credentialing and ensuring adherence to compliance regulations can negatively impact the quality of patient care or delay it altogether.

How Ready Doc™ Can Reduce Healthcare Waste:

Ready Doc™ by Intiva Health is a free medical credentialing software which facility administrators and individual providers can configure to their needs and ultimately reduce healthcare waste.

Distributed Ledger Technology provides virtually impenetrable document security and verification of medical credentials using immutable timestamps. These two important features save time and money by expediting the credentialing process, helps reduce healthcare waste by eliminating the need for excessive paperwork, and diminishes administrative burden for everyone involved.

Automated payer enrollment is an important feature for any medical credentialing software and is an essential process to reduce healthcare waste. On the main Ready Doc™ dashboard, facility administrators can see on their provider roster the enrollment status of a particular healthcare professional. With a few clicks, administrators can request specific documents from providers or upload digital credentials which already exist in Ready Doc™ to kickstart the payer enrollment process.

Failure of care coordination and care delivery is another big driver of healthcare waste. The annual cost of healthcare waste from failure of care delivery is estimated to range from $102 billion up to $165 billion. The annual cost of healthcare waste from failure of care coordination is estimated to fall anywhere between $27 billion all the way up to $78 billion, according to a 2019 study which analyzed data from 54 published reports.

The primary way to reduce the risk of care coordination and delivery failure is to improve the sharing of healthcare data, especially information regarding patients, while maintaining HIPAA compliance. Often times, there is a lapse in care team communication and essential patient information is not seen by the eyes of the specialist it pertains to. Ready Doc™ Messaging is a clinical communication tool which provides healthcare professionals with instant messaging services, video, voice, and file sharing capabilities, group and priority messaging, and delivery confirmation—all while maintaining HIPAA compliance.

These features improve care team coordination with the ability to securely share images such as X-Rays and files such as treatment notes with multiple providers and know when they have received them. It works on mobile devices as well as the desktop platform, allowing all types of healthcare professionals to reduce healthcare waste by communicating effectively and thoroughly.

In other instances, a patient may receive care from a healthcare professional who may have incorrect appointments and hospital privileges. Ready Doc™ allows a facility administrator to see all appointments and privileges associated with a particular healthcare provider on the main dashboard. Additionally, automated expiration alerts for expiring appointments are sent to administrators. This feature of Ready Doc™ reduces healthcare waste since it helps ensure patients at hospitals and surgical centers are only seen by healthcare providers with the correct privileges.

Healthcare fraud and abuse are rampant throughout the industry which also means they contribute to healthcare waste. Healthcare fraud necessitates intent to obtain payment while knowing the actions are incorrect. On the other hand, healthcare abuse may involve obtaining an improper payment or creating an unnecessary cost to the Medicare Program yet does not require malicious intent and knowledge.

In any case, both occurrences cause an extreme about of financial burden on the industry and can be costly to facilities if they engage with a healthcare professional who may have committed either or both offenses.

Ready Doc™ has continuous monitoring of seven state and federal data banks including the Department of Health and Human Services (HHS) Office of Inspector General (OIG) List of Excluded Individuals/Entities (LEIE). The LEIE is a continuously updated list of individuals and entities excluded from participation in Medicare, Medicaid, and all other Federal healthcare programs for a variety of offenses, including healthcare fraud and abuse.

If a provider in the Ready Doc™ platform is found on any of the databanks, alerts are automatically sent to medical facility administrators and any relevant provider. Healthcare facilities and providers always need to know their LEIE status. If a facility hires an excluded individual, or if another healthcare professional is working with anyone on an exclusion list, both the facility and the individual provider can face massive fines and potentially be barred from receiving Medicare reimbursements for one year or longer.

Ready Doc™ helps to reduce healthcare waste with the capability to alert individuals and entities if an exclusion violation ever occurs.

Healthcare waste is undoubtedly an issue that needs to be tackled from various angles within the industry. It doesn’t matter if you are within the C-Suite, a facility administrator, physician, or a nurse. Anyone that works in the healthcare industry or a related field such as an insurance agency can play a role in reducing healthcare waste.

The essentials to reducing healthcare waste are technology that replaces manual processes such as medical credentialing software, improved communication for care coordination and care delivery, and maintaining compliance.

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