Provider-Centric Approach to Fixing a Broken Health Care System

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“Health care is broken.” That is the simple assessment made by Mary Dees Griffith, president and COO of Preferred Health Technology (PHT), of a system where the average patient pays their doctor’s bill 120 days after the service was rendered – 90 days past due – and, where nearly 50% of providers are never paid for their services once the patient leaves their office.

“Healthcare,” said Griffith, “is a consumed service that like a hotel stay or rental car use, cannot be recaptured.”

Griffith notes that we can never check into a hotel or rent a car without providing a form of payment when we check-in. Physicians offices, on the other hand, simply record information from our health insurance card, maybe collect a copay, and then bill the patient for any services that were not reimbursed by the insurance carrier.

“The A-Claim Solution was developed by PHT in conjunction with BlueCross BlueShield of South Carolina and Visa,” said Griffith. “It is a provider-centric approach that takes advantage of real-time claims adjudication to determine at the time of service what the patient owes, coupled with a payment terminal or web application that allows for the physician to offer patients a variety of payment options.”

“One issue we have, said Griffith, “is that few payers can currently adjudicate a claim in real time.”

Despite the fact that few health plans can provide the real time claims adjudication that takes the guesswork out of determining patient responsibility at time of service, Griffith said that the PHT system still can deliver value to physician practices.

The terminal, or web application, will allow the physicians office to offer an estimated amount of the remaining patient balance and accept and securely store debit or credit card payment information until such time that the claim has been fully adjudicated. At that time, the amount due, not to exceed the estimate, is applied to the card.

The system allows for split-tender transactions where, for example, an FSA prepaid card could be charged, and any remaining balance be applied to a credit card. Furthermore, the system can set up an automated payment plan that will apply an amount to the card on a regular basis thus spreading larger payments over time.

“In either case,” said Griffith, “we have increased that physician’s revenue and eliminated the need for repeat billing.”

Griffith said that new programs are being rolled out that will allow insurance carriers to automatically access funds from their member’s HSA accounts to be included in the settlement amount forwarded to the provider. Also, the API will be made available soon allowing patient management systems to deliver one, or more, of the A-Claims solutions through their interface.

Currently there are a few thousand providers are using the A-Claim solution across the country through participating practices, billing services or hospitals. The cost of the special terminal is less than $500.  If someone prefers to utilize the web portal instead of a terminal, PHT charges a monthly license fee per user in the office instead. If an office is already using a compatible payment processor, they can get set up and running in the same day. If a new processor set up is required it takes about a week.

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