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By Linda Parks MA, RHIT, CCS
“Blockchain may be a new concept for many healthcare providers, but it has the potential to fundamentally change the way health data is shared, stored and secured.” Although this statement was the headline for a Health IT Analytics article from February 2017, it is just as true today as it was two years ago.
So, what does that mean to you as a coder or a biller?
As we all know, the revenue cycle in healthcare has several steps, from the time the patient encounter begins at the front office through the physician documentation of the visit to the back-office coding, bill drop, DNFB, remittance, and—if needed—appeals. We know this process can be slow and tedious and our technology can be vulnerable to breaches.
So, perhaps a better question is: what is blockchain technology and what does it have to do with the healthcare revenue cycle?
What if there were streamlined claims submissions, remittance, and payments for the provider with real-time determinations and claims adjudication for the payers? In this perfect world there would be more accurate claims payments, lower accounts receivable balances, and less reliance on collection agencies. You would make fewer calls to healthcare plans for payment status, fewer duplicate claims submissions, higher productivity for your billing department, and greater patient satisfaction.
There is a lot of excitement in the health IT world about blockchain technology. The revenue cycle is one of the areas being explored for potential uses, with an eye to eventually connecting payers to providers with an end-to-end transaction from encounter to discharge to payment.
Blockchain technology was originally conceived as an infrastructural component of cryptocurrency—namely, Bitcoin. Proponents have stated that healthcare would seem a next logical step for its use because it combines the properties of verifiable financial transactions and meets the demand for solutions in data storage, security, and integrity. Still not sure about the connection?
Three advantages to payers:
- It gives them the ability to keep a record of transactions
- It can connect payers to the electronic health record
- It can automate time-consuming tasks such as claims adjudication and prior authorization
More importantly, from the provider standpoint—and to us in health information management—there are advantages: blockchain provides a lot of control over what happens to patient information because it is based on a list of records (blocks) that are linked and secured through a process of protocols that prevent third parties or the public from reading private messages. Each block has a timestamp and transaction data. Once recorded, the data cannot be altered without notification of all subsequent blocks. This makes it less vulnerable to breaches. Participants can share access to their networks without compromising data security and integrity, because only providers and payers who have agreed to participate/share will have access.
A defined series of identical copies of information is held locally by every member of the chain, instead of in a single, central repository. When one entity within the community wants to make a change or addition to the data set, every other participant must agree that the change is valid. Once the action is approved, every locally-held copy of the data reflects that the edit took place. This ensures that everyone stays informed of all changes and has a chance to dispute an edit, or block access if an unauthorized entity tries to tamper with the data.
Value-based care is an initiative that is accelerating the need for data sharing for the purpose of improving quality, reducing costs, and enhancing the patient experience. From what I have read, blockchain would seem to fit into the value-based healthcare scenario, by sharing data seamlessly, ensuring the integrity of the patient data, and reducing administrative costs.
Speaking of data sharing, by linking together participants, all with shared power and responsibility to track changes through timestamps and confirm that transactions are valid and allowable, blockchain has the potential to break down barriers of trust that are holding back more widespread use of blockchain technology. Trust in the security of the technology and trust in the partners in the network is slowly developing as more and more organizations are hearing about the benefits of blockchain. And let’s face it, who wouldn’t want the benefits of faster turnaround in payments, reduced fraudulent billing, automated payment processing activities, reduced administrative costs, and recovered time for both payers and providers?
Sounds good, right? I think we are going to hear more about blockchain technology in many areas of healthcare delivery, including the revenue cycle. What do you think? Let me know in the comments below.
Linda Parks is associate professor of HIM at Dakota State University.