Making billing and payment systems electronic reduces processing costs.
Wow. I don't know where to begin. This is a lot more variable than you'd think.
I think the following statement is much more accurate.
Making billing and payment systems electronic has the potential to reduce processing costs.
Keep in mind that the adoption of E-mail did not eliminate mail fraud or reduce the labor involved in processing mail.
I'd argue I spend more time processing my mail than I did in the 80's. It might have reduced the costs of sending an individual letter using a stamp. Your actual results may vary. Do did you buy Microsoft Exchange server, Outlook? Oh wait...it's not a purchase...its a temporary license. Did you have to renew the license? At what cost? Did you send 90 letters out last year? 200 letters? How about when measured as "cost per correspondence" that year? When you renewed software licenses under the new version, could you continue to use your orginally purchased hardware? ...or did you have to upgrade your hardware as well? Was your labor cost free? If you used a "free" provider, such as Yahoo, how much time did you spend fiddling around, following animated Yahoo links. Does your time have value?
Medical billing system goals and project architectures vary. There's a lot more to this than coding medical procedures or reducing the human clerical involvement in working with Medicaid. I analyze and track the success of various medical IT projects and there are too many failures sold as successes and the costs shifted around, but ultimately paid by citizens, self-insured customers, quality of care, quality of non-medical service. Definitions of "success" vary from person to person and many are not based on objective, measurable criteria.
Keep in the mind the labor for regulatory compliance, developing and managing electronic systems runs $35-$230/hr. Accounting clerk and medical-coding labor runs $16-$40/hr and "maintenance" involves periodic training. The labor cost ranges can actually be wider depending on the economy of that region. Think New York City vs. Podunkville, WV. Keep in mind that there are often unplanned and improperly budgeted costs such as security and maintenance. The medical coding and accounting clerk labor typically is not eliminated, but retrained to use the new system and often given a raise to retain them after the training, because they are in more demand. The transaction labor time is often increased in the new system and the transaction errors harder to detect and diagnose because of the increased specialization and fragmentation of knowledge about the system.
Some of the billing labor requires maintaining industry certifications. As standards become more internationalized, there's potential for labor savings by exporting the jobs and broader sharing of expertise. Sometimes these savings are offset by increased coordination and communication costs (not long-distance fees, we're talking subtle mis-communication with big impacts resolution of business outcomes) caused by the shift from localized clerical work to exported clerical work.
I've seen many implementations where total operating costs, per unit of the same function, dramatically increased AND it created new costs, hidden by being created in other departments, such as, Legal, Customer Service and Communications.
(Did lawsuits increase? Was there more confusion about work-products? Was resolution of the confusion easier or harder? Did we have to "educate" our customer on our system with PR campaigns? What did that cost? Was it effective?)
If we ignore all the issues that come with new implementation projects and switch our focus to the new power of having more (and better?) data to sift...that's easier to analyze, there are two sides to that coin.
1. Automated algorithms make it easier to detect some types of fraud. (in email analogy, spam)
2. Automated systems (and the presumed security and trust in them) make it easier to hide fraud and do it on a wider more efficient scale.
3. Organized criminals love automation and bureaucracies. It makes crime less messy. Those that care to make money via fraud may be better financed, more technically sophisticated, more agile and better focused than the middle-income workers trying to prevent it...and detect it using their security-crippled IT-security compliant machines.
4. Misdirection and false evidence is significantly easier to create with automation and harder to detect.
Coding systems and regulations inevitably force otherwise honest actors into an ethical lie, and through boiler-plate language, CERTIFY the lies are true and complete to the best of their knowledge.
To Illustrate this, let's ignore the specialized technical complexities of medical problems. Let's use "car terms"
Kiosk Example: ALL FIELDS MARKED WITH AN ASTERISK MUST BE COMPLETED BEFORE YOU CAN CONTINUE TO THE NEXT SCREEN. Does your car have a 4 cylinder, 6 cylinder or 8 cylinder engine?
What if you drive a 3-cylinder Chevy Sprint? A 10-cylinder Dodge? A 5-cylinder Audi or Volvo? A cylinder-less Mazda RX-7?
1. Rationalize that the half-empty soda can in your car's drink-holder is...technically...a cylinder.
2. Stand there until the system times you out, losing all your previous entries.
3. Lie, but refuse to click "I certify these statements are true and complete to the best of my knowledge under penalty of ..."
4. Challenge the Department of Motor Vehicles clerk to surprise you by re-coding, re-compiling and re-installing the software for you...without losing your already completed data.
4. Get the DMV clerk to log in with DBA privileges as you verbalize to her the SQL statements necessary to manually correct your record in the DMV mainframe.
5. Do what everyone else does. Fool the system into giving you what you think is the proper result by feeding it false data that several other unrelated systems and unrelated organizations will analyze and reach incorrect conclusions...and hope it somehow doesn't come back to bite you. Especially the "I certify under penalty..." part.
On paper forms, a person can draw a line through the presented number of cylinders and write in "3 cyl" or "12 cyl" then sign the certification. This transfers the perjury/penalty risk away from you to the person that has to force it into another category. I classify this as a data-quality and answer-motivation issue.
In a few thought experiments, we can easily imagine the issues and abuses that occur by fixing the cylinder question with "Other" That was just a pretty straight-forward and predicable car example.
Let's consider the inherent complexities of disease, time pressure, Medicaid mandates and underpayment, inconsistent federal rule-making, clerical interpretation of the rules and the fact that diseases and symptoms just don't care what laws are passed or what data-structures and classifications exist.
You have the beginnings of job security for highly-paid consultants like me! At what cost? Who do the hospital administrators pass those costs onto, insurance companies? Other departments? Higher Premiums to consumers? Medicaid? Treasury Department? Ben Bernanke? Chinese sovereign-wealth funds? Wealthy Donors? I bet that it's anyone they can!
Employees need expensive healthcare. Robots don't need expensive healthcare. Cool.
