The Medicaid program compared to Medicare and commercial health insurers isn’t nearly as efficient at processing electronic claims information.
But if Medicaid, a program run by individual states and the federal government, were to use more efficient and universal claims processing codes, there is an opportunity for the Medicaid program to cut administrative costs related by as much as $4.8 billion annually, says the Council for Affordable Quality Healthcare, a Washington, D.C. coalition of more than 130 companies and organizations pushing better use of universal standards for sharing and processing healthcare data.
“The benefits to enrollees, taxpayers and government programs from efficient operational processes and electronic transactions are significant,” says Council for Affordable Quality Healthcare president Robin Thomashauer.
The report is essentially a push by the council for healthcare providers that bill Medicaid to adopt four sets of universal claims processing standards such as for prior electronic claims authorization and get certified by the Council for Affordable Quality Healthcare.
The council didn’t say much in its findings about how specifically it reached a figure of $4.8 billion in administrative savings.
Today, state agencies and health plans covering 44% of all Medicaid enrollees have achieved some level of electronic claims processing certification from the Council for Affordable Quality Healthcare, the council says. This compares to 78% for commercial health plans and 75% for Medicare Advantage plans, according to the council.
By adopting four phases of operating rules for electronic transactions Medicaid payers can reduce overhead expenses and direct more state and federal tax dollars toward patient care, the council says. For example, Medicaid payers in Florida could save $177 million, Illinois could save $294 million and those in California could save $655 million annually, the council says.
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