Denied insurance claims are among the biggest challenges facing the U.S. health care system – driving up costs and leaving providers with billions in unpaid bills. Hilal Atasoy, an associate professor at the Rutgers Business School, thinks she’s uncovered an elegant if simple solution: better software management. Her paper on the topic appears in the September issue of the journal MIS Quarterly. Medical claims contain a range of information, including patient demographics, medications, medical histories and procedures performed. Claims can be denied when they include erroneous information or uncovered services, among other errors.
To strengthen the quality of health data that doctors collect, in 2009, U.S. lawmakers adopted the Health Information Technology for Economic and Clinical Health Act, or HITECH, which incentivized the use of electronic health record (EHR) systems. The goal – lauded at the time – was to make technology the “foundation for health care reform.”
It was only partially successful. While the move incentivized adoption, the resulting mix of systems from different vendors created interoperability challenges that can contribute to claim denials, Atasoy said. When software used by one clinic or hospital system differs from another, patient data can get jumbled or go missing – making denials more likely. To read the full story.