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Reducing health care costs using claims adjudication software.

L G Miller1

  • 1Health Payment Review, Inc., Boston, MA.

Physician Executive
|April 8, 1993
PubMed
Summary

Reducing health care costs involves improving physician service coding. Advanced software systems offer consistent claims review, leading to significant savings for payers and enhancing competitiveness for both traditional and nontraditional organizations.

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Area of Science:

  • Health economics
  • Medical informatics
  • Healthcare administration

Background:

  • Incorrect coding of physician services represents a significant area for potential reduction in healthcare expenditures.
  • Current software systems are effective in performing high-volume, consistent claims review, yielding substantial cost savings for payers.
  • The evolution of claims review software aims to address these inefficiencies.

Purpose of the Study:

  • To highlight the cost-saving potential of advanced physician service coding software.
  • To introduce the capabilities of third-generation claims review systems.
  • To discuss the broad applicability of these systems for various healthcare payers.

Main Methods:

  • Analysis of current software systems for physician service claims review.
  • Evaluation of the capabilities of third-generation claims review technology.
  • Assessment of cost-saving impacts and system applicability across different payer types.

Main Results:

  • Current software systems demonstrate high-volume, consistent claims review, resulting in significant savings.
  • Third-generation systems provide comprehensive coverage across clinical disciplines, individual claims, and historical claim data.
  • These advanced systems are poised to deliver value to a wide range of healthcare organizations.

Conclusions:

  • Advanced software for physician service coding is crucial for reducing healthcare costs.
  • Third-generation systems offer enhanced capabilities for comprehensive claims review.
  • These systems are beneficial for both traditional and nontraditional payers aiming for cost reduction and improved competitiveness.

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