Before you can understand how blockchain is changing healthcare, specifically billing and claims and revenue management, it’s key to clearly understand what blockchain is. Here’s the definition according to Investopedia:
“A blockchain is a digitized, decentralized, public ledger of all cryptocurrency transactions. Constantly growing as ‘completed’ blocks (the most recent transactions) are recorded and added to it in chronological order, it allows market participants to keep track of digital currency transactions without central record keeping. Each node (a computer connected to the network) gets a copy of the blockchain, which is downloaded automatically.
“Originally developed as the accounting method for the virtual currency Bitcoin, blockchains – which use what’s known as distributed ledger technology (DLT) – are appearing in a variety of commercial applications today. Currently, the technology is primarily used to verify transactions, within digital currencies though it is possible to digitize, code and insert practically any document into the blockchain. Doing so creates an indelible record that cannot be changed; furthermore, the record’s authenticity can be verified by the entire community using the blockchain instead of a single centralized authority.
From that definition alone, it’s easy to gather how the complicated, highly confidential world of billing and claims and revenue management could use the help of a blockchain system. But let’s take a deeper look at some of the ways blockchain could change the game when it comes to billing and claims, and revenue management.
Anyone who has worked in billing and claims knows that it’s an imperfect system. There are dozens of opportunities for error.
Blockchain creates the opportunity to make all information accessible by all parties: insurance providers, clearinghouses and healthcare providers in one central space. This means that regardless of how many payer networks a provider is part of, or if a provider relocates or changes networks: only one system needs to be updated, and everyone uses it.
The idea of everyone accessing provider and patient data from the same central space would revolutionize the system and greatly improve billing and claims accuracy.
According to Lexology, 40% of payer’s provider data contains errors or missing information.
Blockchain eliminates the need for sitting on the phone for two hours to figure out that a patient ID number should have contained a “3” instead of an “E.” Or to figure out that a claim is being denied because at the time of service, the healthcare provider had switched networks.
In his LinkedIn Pulse article, David Houlding — Director of Healthcare Privacy and Security at Intel — explains that “any removal of a block, or tampering with the information stored within a block is easily detectable.” This key characteristic means huge opportunity when it comes to protecting sensitive data. However, he notes that in order for blockchain to be beneficial to security, a group or business must play an active role in implementing protective measures.
“In general blockchain does not automatically provide protections to confidentiality, or unauthorized access to information stored on the blockchain. In the extreme case of public blockchain all information stored on the blockchain is visible to anyone that cares to look. While this may be suitable for certain public health use cases, most healthcare use cases involve highly sensitive and lucrative information that is vulnerable to abuse, and therefore access to this information must be strictly controlled and limited to authorized organizations and individuals only. Supplemental strategies such as private and permissioned blockchains, encryption, and other safeguards can help control access to the blockchain and information stored on it, and mitigate risk of unauthorized access,” Houlding explains.
Have more questions about blockchain? Want to start using new software to improve your business? Contact DENmaar today at 1-888-595-5101, or email at email@example.com.