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The McKinsey & Company Quarterly, dated 2007, stated that the healthcare sector lacks the kind of modern payment system found in retailing. Physicians, hospitals, and laboratories have designed their pricing and billing systems around wholesale (business-to-business) relationships with insurers. Transactions move in batches, long after patients have left their doctors’ offices. Providers have only a limited ability to estimate their patients’ liabilities at the point of service. Even when they do, few can present bills at the time of treatment and process credit- or debit-card payments.
Instead, providers must submit and settle claims with insurers and then rely on the “send a bill and hope the patient pays it” approach for any shortfall after claims settle. To confuse matters, patients also receive an explanation-of-benefits statement, or EOB, from their insurers. This document, which says “This is not a bill” in large type, frequently shows the patient owing an amount different from the one indicated on the provider’s bill. The costs and complexity of consumer billing and collections are onerous, especially for physicians’ offices, where the dollar amounts per visit are relatively small and success rates for payment of the post-insurance balance often low. As a result, physicians and hospitals typically collect only about 50 percent of this balance---and only 10 to 20 percent for self-pay patients. Across the sector, this adds up to almost $60 billion in bad debt annually.
Here we are in 2009. Things have really changed in the world today, with the economy being in a state of decline. Companies are closing at an alarming rate or are laying off employees. Medical practices will inherit greater issues/challenges on top of their current issues. These issues can have a major impact on medical practices that provide basic services. How do we streamline the process? Or make the process less costly?
1. Utilize modern technology that allows a medical practice to verify insurance eligibility in less than one minute, saving valuable staff time and increasing a practice’s bottom-line.
By using the A-Claim technology, a medical practice would be able to save time and resources by verifying insurance eligibility in less than one minute.
2. Provide a faster more efficient process in which the doctor can receive payment(s) at the time of services performed/rendered once the amount of the patient’s responsibility has been determined by his insurer (after the EOB is processed).
A-Claim would allow the patient to make payment arrangements before the patient leaves the hospital or doctor’s office, providers can increase the efficiency of their billing process and improve overall collections and cash flow.
To prove my points listed above, the following examples:
When a patient checks in, they give the receptionist their insurance card and sign in at the desk. While the patient is waiting, office staff verifies the patient’s insurance eligibility. This could take from five to fifteen minutes per patient or longer and if the practice sees twenty-five to thirty patients a day, can create a bottleneck in the waiting room. A question to ask your staff is how much staff time is spent collectively per day verifying eligibility.
A-Claim would reduce the bottleneck and time spent on the phone confirming patient eligibility by allowing the front-desk person to swipe the patient’s insurance card at the time of service and allow for a response in seconds that would include the following information:
- Instant insurance eligibility verification with all major insurance companies;
- Patient payment responsibility, including in-network or out-of-network information; co-pay amounts; annual deductible information; and more.
Another example: Just imagine if your medical practice had invoices for services rendered that were being carried on the accounts receivables in the amount of $10,000 to $30,000 for 45 to 60 days.
A-Claim provides technology that patients can swipe their preferred credit or debit card to quickly settle their financial responsibility at the time of their visit and allows the practice to establish a payment plan for costs that exceed patients' immediate ability to pay.
“Today’s advances in health technology provide an opportunity for cost savings and efficiency in several areas of a medical practice including accounts receivables,” said Mary Morin, Executive Director of the Anne Arundel, Howard, and Prince George’s county medical societies. “Many vendors provide a free analysis that projects cost savings for a practice. Although the county medical societies do not endorse any specific products, they do recommend practices take the opportunity to evaluate the latest health technology, and consider a free analysis to determine if incorporating health technology into the medical practice will provide more efficiency and a reduction in overhead,” she said.
In closing, the business of healthcare is becoming increasingly complex. Today, providers need solutions to speed their accounts receivable collection, reduce administrative costs, and improve their cash flow management. I believe the functionality of A-Claim will create greater efficiencies and cost savings for many providers and increased convenience for their patients.
Maurice Shane Sr. is an independent agent for Signature Business Solutions. Contact him at 202-365-2807 or mauriceshane@gmail.com.
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