“Digital Health” is often centered on EHRs and Meaningful Use to the detriment of many other technologies that can help improve patient satisfaction. To help make sure that we don’t forget how useful modern technologies are to actually getting paid for medical services, I invited Jay Fulkerson, president and CEO of Health Payment Systems (HPS), to take us through the most important issues surrounding claims and payment tech. Prior to his role at HPS, Fulkerson served as chief executive officer of Touchpoint Health Plan (which was acquired by United Healthcare) so he knows the payment space pretty well. Here’s what Jay had to say about the power of health claims technology:
Technology has driven many important changes in healthcare delivery over the years, and now it’s tackling healthcare billing. The current processes are often messy, confusing and wasteful, but like EMR revolutionized medical records, claims technology has the potential to revolutionize payment. Today’s technology can streamline the payment process, close existing gaps or delays, and better connect its components. Here are some tips for harnessing these emerging technologies:
What claims technology can do
- Technology can now combine all medical bills into one monthly statement for the entire family. It includes the family’s medical claims, from multiple healthcare providers, and helps patients review their monthly out-of-pocket healthcare expenses in one, easy-to-understand format, similar to a monthly credit card statement.
- Today’s claims technology allows quality leaders to gather de-identified claims data into a centralized data warehouse that can drive further improvements in benefit delivery and care delivery. It overlaps with other technology efforts related to EMR, health informatics and clinical business intelligence.
- Advances in healthcare technology now let patients track how individual hospitals and doctors rate on cost, quality, and by procedure. This kind of transparency is what people expect when they shop for big-ticket items in any other industry. They compare prices at multiple places to make sure they’re getting the best deal. Technology now gives them that option in healthcare payment too.
- Care is increasingly delivered through an Accountable Care Organization (ACO) or other large in-network affiliated provider group. As coordinated as those organizations are when it comes to delivery, it often isn’t reflected in their billing processes. So, patients are left with a confusing assortment of bills from facilities and providers they may not even remember visiting. Technology synthesizes those claims—one bill for the patient, one claim number for internal billing offices and HR managers.
- More and more patients are paying claims through online portals, tracking their claim information with smartphone and tablet apps, and proactively comparing expected costs from individual providers. What are you doing to give them those options?
How you can use it
- Consider technologies that can “overlay” current business office systems without requiring a specific software change.
- Look for software that allows the provider and third-party administrator (TPA) to connect electronically, simplifying the adjudication of a claim and resulting in a single electronic payment of both payer and patient portions of a claim. This improvement drastically …read more
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