Raymond D. Aller, MD
Michael Weilert, MD
Two vendors bank on health care cards to clean up routine medical claims
What would the health care industry be like without the paperwork and administrative
costs incurred in processing routine claims and determining standard information,
such as copayments, deductibles, and eligibility? A lot healthier, say two companies
that are developing technology they hope will transform the way health care
transactions are processed.
"My goal is to create a national health care network to do routine health care transactions," says Joseph E. Wolfson, president and CEO of HealthTransaction Network, Williamsville, NY. Wolfson pioneered the electronic banking/automatic teller machine network in the United States in the early ’70s, and he plans to use that expertise to create an automated network connecting payers, providers, and consumers to make the health care transaction process run more efficiently.
The other player is Denver-based First Data Corp., an electronic commerce and payment services company that handles financial transactions for millions of consumers.
The technology that HTN and First Data are using involves a plastic card and a device that is similar to the credit/debit terminals found at retail stores. Like a credit or debit card, the health care card contains a magnetic strip that, when slid into the point-of-sale (or in this case, point-of-care) device, accesses a card holder’s health care information, such as copays, deductibles, and funds in a flexible spending account, along with other related information.
As of January, both companies were initiating pilot programs to test their
new health care cards. HTN has letters of intent to work with several health
insurance and health care providers in western New York, including Health Now/Blue
Cross Blue Shield of Western New York, Independent Health, Kaleida Health, Catholic
Health System, University Orthopaedic Services, and Buffalo Medical Group.
The plan is to implement the program in phases. During the first phase, providers will be able to identify the health care consumer, determine insurance eligibility, and obtain referral verification and copay requirements. HTN’s smart card will also function as a debit card for out-of-pocket health care expenses that are associated with card holder spending accounts, such as flexible spending accounts. The card incorporates the use of biometrics, including fingerprint and signature recognition, for patient identification.
At CAP TODAY press time, First Data was scheduled to begin a pilot program with doctors in the Atlanta metropolitan area for its latest health care product—an eligibility card. A health care consumer’s eligibility and coverage information can be verified by swiping the card through a point-of-care terminal. "We actually have processed live patient eligibility transactions, which we were pretty excited about," says First Data’s vice president of product development, Robyn Bartlett-Andersen, referring to an earlier beta program begun in January and involving fewer doctors. "So far the beta testing has gone well and participating doctors have been saying, ’Wow, this is great. Could you do this?’" she says. "So what we’ve gotten is more ideas for future capabilities that we want to add onto the application."
First Data launched its initial health care product, a multipurpose health care card, in October 2003. The debit card can be used to access consumers’ health care spending accounts. The value of the card is that the POC device can automatically substantiate the transaction without the need for receipts or the hassle of reimbursements, says Bartlett-Andersen. "So with the card, they [consumers] have immediate access to their funds."
The eligibility and debit cards have not been combined due to business workflow rather than technical issues, she adds, "but our vision is to move toward adding as much utility to a card as makes sense from a business perspective."
While HTN and First Data are at different stages with their initiatives, both companies plan to add a claims-processing function to their respective cards. Claims for routine health care services, such as check-ups or screenings, would be automatically processed, meaning providers will receive payments faster. "No more waiting for 40, 60 days, things like that," Wolfson says. "The doctors will now get their money the same day, that night, through the ACH, the automated clearinghouse."
Providers and payers will also benefit by saving on administrative costs, Bartlett-Andersen says. "Our vision is really connecting the claims and the payment side so that, long-term, we can get to faster, more accurate, less costly mechanisms of getting that payment loop closed," she explains.
The same-day claims-processing offering is what’s most interesting to Michael Quinn, chief financial officer for University Orthopaedic Services, a physician group based in Buffalo, NY. The practice, which is also the teaching group for the University of Buffalo medical school, employs about 100 people, 17 of which are doctors. "Currently, it takes us 30 to 45 days to sometimes two years to collect on a claim. And that is just unacceptable. HTN seems to be able to offer a solution to that," Quinn says.
Quinn adds that the man-hours saved through automatic processing can be used toward settling more complicated, costlier cases in the thousands of dollars. The proposed network, he says, is appropriate for such practices as primary care offices and pathology groups that have routine billing transactions, as well as for specialty groups, such as orthopedics.
Under the HTN plan, the provider and payer will be charged a small transaction fee, says Wolfson, the amount of which has yet to be determined. The fee will be nominal, he adds, compared to the cost savings that payers and providers will accrue.
Wolfson says the claims-processing function will be added to the network during the second phase, which will begin some time this year. More capabilities, including a mechanism for sharing patient health information, such as electronic medical records, will be added to the card over time.
First Data’s automatic claims-processing function should be available in the second or third quarter of this year, Bartlett-Andersen says. To encourage doctors to use the system, First Data is supplying them with POC terminals. First Data is also working with its customers to issue debit and eligibility cards to consumers, although payers have the option of issuing the cards themselves.
Physicians initially have been skeptical about how insurance companies will receive such a system, says Wolfson, especially one that would have claims, and therefore payments, processed faster. But, he adds, because health care costs are rising an average of 14 percent per year, providers and payers are realizing that something needs to be done.
"This is less about technology and more about a culture change," says Wolfson. "This is easy—the technology side of it."
Elekta to acquire Impac
Elekta AB and Impac Medical Systems have announced an agreement under which Elekta will acquire Impac, a provider of information systems for managing radiation, medical oncology, and related clinical practices.
Under the agreement, Impac will operate as a wholly owned subsidiary of Elekta, a supplier of clinical solutions for radiation treatment of cancer and noninvasive or minimally invasive treatment of brain disorders.
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CAP licenses nursing mappings to NLM
The College of American Pathologists has licensed to the National Library of Medicine mappings from SNOMED CT to NANDA International Taxonomy II, Nursing Interventions Classification (NIC) version 4, and Nursing Outcomes Classification (NOC) version 3. The National Library of Medicine will provide access through its Unified Medical Language System Metathesaurus, a source of biomedical concepts and terms from controlled vocabularies and classifications.
Beginning later this year, each mapping will be available, at no charge, to Unified Medical Language System users who are licensed to use the Systematized Nomenclature of Medicine Clinical Terms, or SNOMED CT, and the specific nursing terminology involved. The mappings and SNOMED CT will continue to be available directly from SNOMED International.
NANDA Taxonomy II provides nursing diagnostic concepts that identify and code a patient’s responses to health problems or life processes that explain the variance in patient outcomes that differs from the variance explained by disease diagnoses. NIC encompasses nursing interventions used in all clinical settings and is used at the point of care to document care planning and nursing practice. NOC includes a comprehensive list of nursing outcomes to evaluate the effect of nursing interventions on patient progress.
Misys receives FDA clearance for blood bank and donor modules
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This FDA designation allows Misys to market the newly enhanced graphical user interface blood bank modules on IBM AIX, HP Open VMS, and HP Tru64 Unix operating systems.
Spectral Diagnostics ships connectivity system
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The i-Lynx handheld device is a battery-powered portable instrument that accompanies the Cardiac STATus rapid test to the patient’s bedside. The unit contains an interactive PDA-style color touch screen and a built-in bar-code scanner. Custom software allows laboratorians to implement and monitor all required quality assurance procedures, even at a decentralized testing location.
The i-Lynx docking station has printing and LAN communication capabilities that automate the collection and transfer of patient testing data.
The initial instrument application will be part of Spectral’s Cardiac STATus point-of-care testing system.
The United Kingdom’s University College London Hospitals NHS Foundation Trust has selected CoPathPlus from Misys as its anatomic pathology information system
TheraDoc has signed a contract to install its entire suite of expert clinical decision-support software at the University of Mississippi Medical Center, Jackson.