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Several readers have contacted Hospital Access Management asking for more information on the health care payment network described in the January 2001 issue. The company featured in the article, Del Mar, CA-based MedCambio, promises its hospital and physician clients a switch from 72 days in accounts receivable to 72 hours.
MedCambio aims to makes good on that claim by implementing a system that will calculate reimbursement at the point of service. It pays the provider immediately, based on a percentage of the calculation.
In response to the article, Peter A. Kraus, CHAM, business analyst for patient accounts services at Atlanta’s Emory University Hospital, points out that insurance contracts don’t always pay according to calculations. "Managed care contracts can be ambiguous, and there’s always the issue of whether the patient should be having the particular treatment in the first place." Kraus also observes that the examples in the article were for specific outpatient services, and wonders if the concept is adaptable to extended inpatient care.
The article’s subhead, "Wave bye-bye to the billing department," prompted Kraus to ask if MedCambio would assume responsibility for getting the account billed in addition to replacing collections. (It’s actually manual billing that’s likely to become obsolete if the electronic commerce that MedCambio promotes becomes widespread.)
Kraus notes that insurance carriers demand enormous amounts of documentation from medical facilities, which they often use as a delay tactic to avoid paying the claim. "The article doesn’t explain," he adds, "what MedCambio proposes to do to make even relatively routine billing and collection problems disappear for them."
Carol Miller, vice president of the MedCambio Alliance Partnership with Superior Consultants, a part owner in the enterprise, addresses Kraus’s concerns as follows. "We agree that insurers are difficult to do business with, that they can deny claims, delay payments, ask for additional information, etc. However, MedCambio and its alliance partners are working with major insurers to develop direct routes of claims submission with totally clean claims."
It is MedCambio’s intention, Miller says, to understand the benefit and data requirements of the major insurers, to direct the provider’s or hospital’s claims through its system to ensure that they are "clean," and then to have the hospital or provider submit the claims directly via the Internet portal.
"Besides this piece," she adds, "MedCambio is planning on developing direct and close working relationships with major managed care organizations and insurers to provide cost savings to provider, hospital, and insurer by reducing unnecessary man-hour costs in obtaining payment on claims." This will enable the insurers to reduce their own internal cost to process a claim, Miller notes, and will reduce the burdensome back-and-forth telephone calls involved in trying to get the claim resolved.
Although MedCambio will not personally "get the account billed," she says, it will offer one of its partners to expedite the Internet eligibility and billing process if the hospital does not have an appropriate Internet vehicle in place.
"MedCambio and its partners," Miller says, "are interested in reducing, not eliminating, the back office collection process by improving the Internet portals for eligibility, authorization, and billing on the front end and electronic auto adjudication and posting on the back end." This will prevent human cracks in the process, she says, that can keep missed charges and late charges from being billed in a timely manner.
While MedCambio’s demonstration sites initially have focused on outpatient operations, a company spokesman says, plans are in place to implement the payment network for inpatient services, as well.
[Look for more information on this reimbursement technology in future issues of HAM. If you would like to offer feedback on this issue, or any other of interest to access managers, please contact editor Lila Moore at (520) 299-8730, or through e-mail at email@example.com.]