It used to be you went to the doctor because you had a pain. Then, treatment got so expensive, you got a pain. Today, it's painfully confusing to figure out whether you, the insurance company or the government is footing the bill.
But it's not any easier for the over 600,000 health-care providers nationwide, that army of doctors, dentists, specialists, clinics, hospitals and others that treat aches and pains.
Providers are swamped with paper and paper work as they determine patient eligibility and the proper payer for each treatment, and then collect payments from patients and payers.
There is an upsurge in efforts to automate much of the information and payments-related aspects of the healthcare industry.
The new systems, acting as intermediaries between providers and payers, theoretically will check for patient eligibility, effective date, the type of plan the patient is in, the applicable payer information, and what providers the patient is linked with. These systems will also process the patient's payment, whether through debit or credit card, check, or electronic benefits transfer.
The dollars spent on fixing people up are huge. In 2000, Americans spent $1.3 trillion, or $4,637 per person on heath care, according to the U.S. Census Bureau.
Automation of providers' office point-of-sale systems will bring myriad benefits, according to proponents. Eligibility searches will be sped up along with payment, thus lowering billing costs, improving cash flow, and decreasing bad checks.
Theoretically, payers will get checks out faster to providers, and speed bills out to patients.
"Typically service is provided, then you figure out who pays for it. We try to figure that out at the point of entry," says Dr. Larry A. Saltzman, president of Insurance Benefit Spot Check Inc., known as Spot Check, one of the growing medical payments processors.
Sacramento, Calif.-based Spot Check last year served eight million consumers, processed seven million eligibility requests, and was responsible for claims at over 4,000 provider sites, according to Saltzman.
Spot Check bills providers on a subscription-style model, charging about $50 a month for VeriFone Inc. terminals loaded with Soft Pay merchant card applications and Spot Check software. Spot Check uses national credit bureau TransUnion for address-verification services, and Cross Check for check verification. Spot Check offers both dial-up and Internet Protocol connections.
Independent sales agents for Spot Check receive monthly residuals for sales of point-of-sale terminals and card services to provider offices, says Saltzman.
Participating consumers use a magnetic-stripe card allowing the provider to check the patient's insurer, doctor's name, how much the patient owes the provider, and doctor referral information.
Spot Check acts as an information clearinghouse, interacting with government payers from 36 states, along with major commercial payers like Aetna, Cigna and United Healthcare.
Saltzman estimates that a provider with 500 patients a month could see eligibility and payment-processing costs drop as much as 90% annually by switching to an automated system.
MedCom USA offers programs similar to Saltzman's group, working with over 300 insurance payers and plans. It targets physicians and now serves about 8,000 doctors nationwide, says Michael Malet, executive vice president.
In April, it launched a marketing pact with Hypercom Corp. to sell Hypercom's T7Plus terminals and software.
Scottsdale, Ariz.-based MedCom generates revenues through terminal sales and processing fees. MedCom works with acquirer Moneris Solutions and independent sales organizations.
Rosemont, Ill.-based Abanco International LLC has a more ambitious agenda. It is marketing an entire hardware and software system using a Hewlett Packard Compaq T57 "thin client" with a flat-screen monitor. Abanco's host-based system includes a script pad with a card reader and electronic signature capture in addition to a check-guarantee component. Abanco is marketing its system through its own sales staff, ISOs, and medical sales offices.
Abanco has access to over 300 payers covering 95% of the industry, says Tony Ashe, senior vice president. It uses the McKesson medical clearinghouse for patient information.
Providers pay Abanco a per-transaction fee, in addition to paying a monthly lease on the hardware. Abanco is still rolling out the system. In May, plans called to offer patient eligibility and payments capability. By the end of the summer, it will expand to offer claims settlement.
The medical industry offers a huge new field for cards, both in expanding payments and in automating health care's outdated information infrastructure. Whether doctors will take this cure remains to be seen.
Authoritative analysis and perspective for every segment of the payments industry
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