to assess the need for implementation of health

7/31/2019 To Assess the Need for Implementation of Health

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To Assess The Need ForImplementation Of Health Insurance

Software For Streamlining InsuranceClaims Processing In Hospitals Of National Capital Region Of Delhi.

Dr.Sneha Bhardwaj (PT)

PG/11/095


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Introduction

Health insurance is insurance against the risk of incurring medical

expenses among individuals. By estimating the overall risk

of healthcare expenses among a targeted group, an insurer can develop a

routine finance structure, such as a monthly premium or payroll tax, to

ensure that money is available to pay for the health care benefits specified

in insurance agreement.

Health insurance taken by individual/ household or a group from the

insurance company voluntarily by the payment of fee called

premium .

Insurance company, in turn, compensates the insured in respect of health

care expenses .


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TPA- Third Party Administrator are the middlemen in the chain of integrated delivery system that brings all the components of health care delivery such as physicians, hospital, insured &insurer into a single entity.

Role of TPA

I N

S U R E D

Issues an ID card.

Provide 24- hourtoll free line ,to

inform in case of aclaim

Arranges for thestay of the patient inthe hospital

TPA negotiates withservice providers

regarding quality of care, credit facility,discounts, packagepricing, priorityappointments andadmissions

I N

S U R E R They carry out all the

administrative workfor the insurer.

Information and datamanagement.

Claimsadministration.

Standardize thetreatmentprocedures

S E R V I C E P R O V I D E R Sends authorization

letter to the hospital

Reimburses thehospital for thetreatment

Provides morepatients to theprovider


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TPA - Health Insurance Services Integrator

Third PartyAdministrator

PolicyHolder

HealthcareProvider

InsuranceCompany

Health Services

B e n e

f i t s

A d m i n i s t r a

t i o n ,

P r o v

i d e r

N e

t w o r k

T P A F e e s


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An insured individual seeks medical attention from a healthcareprovider.

Healthcare provider submits charges to the individuals insurer using a health insurance claim form. .

The charges (or claim) are received by the insurancecompany. Each claim is dated and coded to ensure timely filingand payment

The charges are reviewed to ensure they follow the guidelines ofthe policy and a determination is made to the allowed charge andwhat will be owed by the individual. An Explanation of benefits(EOB) and a check (if necessary) are issued.

The provider reviews the information on the EOB, acceptsnecessary adjustments, and bills the individual for the remainingbalance owed

The Steps in the Claims Process


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Present Process

7

Data EntryPerson

Approver

PayerFinanceManager

TPA

HospitalPatient

Fax

E-Mail

Response viaFax/ E-Mail


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Process Pain Points

8

TPANo StandardizationNo Traceability of recordsDelay in process due to

the incomplete information

Fax transmission errorsNo mapped flow ofinformation

HospitalNo StandardizationDelay in amount approval

due to missing documentsNo mapped flow of

informationInformation transmissionloseAccountability missing

PatientHigh Turnaround timeMental stress due to thelack of intimation about theapproval status

No intimation of the out-of-pocket payment


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HEALTH SPRINT Networks Pvt Ltd

.


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Vision And Mission

VisionWe aim to connect healthcare ecosystem and its key players using web

based technologies to enable valuable use scenarios, which bring

value to our customers, investors, and to the community we live in .

MissionEnabling a web based information exchange platform, which enables

reliable, speedy and transparent payer-provider workflow


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Company Background

HealthSprint Networks is a Healthcare IT services company, founded

in May 2006 by 3 promoters who possess desired & complementary

skills from healthcare, technology and marketing domains.

HealthSprint has formulated clear business programs in healthcare,

and implemented one revenue generating use scenario Web enabled In-Patient Insurance Claims Management Network . This

is one specific instantiation of companys larger program of Payer -

Provider Network .

HealthSprint has a growing customer base of Providers, such asWockhardt, Manipal, and Payers, such as TTK, MediAssist.

HealthSprint has employee strength of 70+, who comes from

Healthcare, Technical and Business arena.


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Process Solution Point Offered By iSprint

iSprint TPAHospitalsProvides

theinformation

to theProvider

Patient

Sendsinformation in aparticular format

Receives andreplies in a

particular format

Patient receivesintimation of

response via SMS


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SCOPE OF SERVICES


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i Sprint Improvement over Current paper BasedProcess

Current PaperBased Process

i Sprint Process

Pre-Authturnaround time

4-48 hrs 30 min-4hrs

Rejection:DischargeSummary/Billing

3-8% 0.5%


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i Sprint Network:Benefits to All Key Stakeholders

Reducedwait timefor Pre-

authorization Early

identification of outof pocketpayments

Eliminatesneed forreimbursements

PATIENT

PaymentRiskManagement

Ability tocollectBalancepaymentfromPatients

FasterSettlement

of Claims-Improvedcash flow

PROVIDER

Reductionin

erroneousclaims-Saving

processingcost, &

paymentrisk

managemen

t

Payer/TPA


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RESEARCH STUDY

To Assess The Need For Implementation Of Health InsuranceSoftware For Streamlining Insurance Claims Processing In

Hospitals Of National Capital Region Of Delhi.


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General Objectives

To determine the need for implementation of health insurance software for

streamlining insurance claims processing in hospitals of National Capital region of

Delhi.

Specific Objective

Market analysis of use of health informatics solutions in insurance.

To know the current procedure followed by the hospitals to exchange information

with the insurance company/TPAs for processing insurance claims.

To determine the time taken by the TPAs to responds at the time initial pre

authorization and at the time of discharge for enhancement.

To know about the loss incurred by the hospitals due to disallowance or rejection

of claims and the reason behind them


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METHODOLOGY

Survey was made to be conducted in 35 identified hospitals however, 23

hospital responded to the survey STUDY DESIGN- Cross-sectional, Descriptive

STUDY AREA- Hospitals of Delhi and NCR.

STUDY POPULATION -

Responsible Heads of insurance departments. Managers of Insurance claim process and who are dealing in TPAs

SAMPLING AND SAMPLING DESIGN:

The present cross sectional study was conducted in the hospitals in Delhi and NCR

region during April-May 2012. The study included 35 hospitals selected through

convenient sampling.


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DATA COLLECTION TOOLS AND TECHNIQUES:

A questionnaire has been developed, pre-tested and modified before

administering it to the selected participants.. Questionnaire consisted of thevarious questions which can tell about the current procedures followed in

various hospitals in handling health insurance claims and the average time

taken at different steps of insurance claim process..

Participants were explained in detail regarding the purpose of the study;

informed consent was obtained and questionnaires were distributed.

Necessary steps were taken to maintain anonymity. Information thus obtained

from the above questionnaire was entered in MS excel spreadsheet and

Descriptive study is carried out to analyze results thus obtained.


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Study FindingsOut of 35 hospitals which were selected to conduct survey 23 hospitals willingly

responded to the questionnaire. The respondent included personnel working at different

responsible positions in the insurance department of the hospitals like Senior Manager

Administrative Officer, C.O.O, TPA/Panel in-charge, TPA executive and Finance

Executive

It was observed that the average number of insurance cases per day are 10 to 15 cases

per day in majority of the cases (44%) followed by 15-20 cases per day in 17% of the

Hospitals.

9%

17%

44%

17%

13%

Insurance Cases per dayLess than 5 5 to 10 10 to 15 15 to 20 More than 20


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In 69% of the respondent hospital the personnel working in the insurance department

comprises of both medical and non-medical graduates only 9% states to have medical

graduates working in their insurance department

70% of the hospitals states that they use Fax and Mail as current process to exchange

information with the TPA/Insurance company and 26% of the hospitals use some

software application along with Fax and mails to communicate with the TPA/insurance

company.

Among those 23 respondent 32% offer cashless hospitalization to patient belonging to

preferred provider network (PPN) and central government health scheme (CGHS) .

23% hospital caters to PPN, Non-PPN and CGHS whereas 5% hospitals deal with

patients with PPN, Non-PPN, CGHS, ESIS and other health insurance schemes.


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In majority of the hospitals the maximum number of insurances cases comes for Vipul

Med Corp TPA Pvt. Ltd (in 20% hospitals)followed by Raksha TPA Pvt. Ltd ( in 17%hospitals as shown by the following graph

3

16 18

5 6 8 913

5 5 1 1 1 1

Number of cases comes from each TPA


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The average time taken for initial response for preauthorization by the TPA/ insurance

company is 0-4hrs in 9% of the hospitals whereas 48% hospitals take 4-8hrs for the

same process and only 39% hospitals takes 12-24hrs for this process.

9%

48%

39%

4%

Time taken for initial Pre-authorization

0-4hrs

4-8hrs

8-12hrs

12-24hrs


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At the time of discharge the average time taken by the insurance company/ TPA for

enhancement of the claim is 2-4 hrs in 30% of the hospitals whereas in 57% of the

hospitals time taken for the same process is 4-8 hrs and about 9% takes more than

8hrs. Only 4% states that it takes 1-2hr for this process to complete.

4%

30%

57%

9%

Time Taken For Enhancement

1-2hrs

2-4hrs

4-8hrs

ore than 8hrs


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The annual insurance billing amount is less then 5crores in 26% of the

hospitals and 17% of the hospitals states their annual insurance billing

amount to be between 5crores to 10crores whereas 9% claims their

insurance billing amount to be between 10crores to 15crores and another 9%of the hospitals states their annual insurance billing amount to be more than

15corores. Majority of the respondent (39%) were unwilling to share their

financial details.

6

4

2

2

9

Less than 5 crore

5-10 crore

10-15 crore

More than 15 crore

Can't tell

0 2 4 6 8 10

Annual insurance billing Amount


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The rate of loss of revenue due to rejection of insurance claims by the insurance

company or disallowance is 4-8% in majority of the hospitals (35%) It was 2-4% of the

annual billing amount in 22% of the respondent hospitals whereas 17% hospitals state

that for their hospital this figure is as high as more than 8%.Only 13% of the hospitalsstate that the rate of rejection of claim is less than 2% in their hospital.

13%

22%

35%

17%

13%

Disallowance rateLess than 2% 2-4% 4-8% More than 8% Can't tell


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Limitations to the Study

List of limited hospitals was provided and not entire spectrum ofhospitals in the region.

All the hospitals were not willing to share their information.

Response is limited to the result based on response of oneindividual in each hospital.

The education of Information technology is questionable for therespondent.

SPSS tool could not be used because the sample size is less than

30.


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Conclusion

Study finding i sprint

Pre-Auth turnaroundtime

4-8hrs 30min-4hrs

Rejection: DischargeSummary/Billing

4-8% 0.5%

The finding shows that the Pre-authorization turn around time and rejection

rate can be reduced by using IT software application as claimed by isprint.


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Qualitative Analysis of the study

There will be more accountability and traceability.

Privacy and security of the data will be maintained.

Interoperability between different records.

Better Filling and retrieving of records. Integration of records

Ease of handling of comprehensive records

Availability of Data for research purposes.


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Recommendations

From the study findings it is observed that there is a need for

implementation of IT for streamlining health insurance claims. This

would result in improved claim processing thereby improving

services for patient, provider, TPAs and insurance company,however training is required for TPAs and insurance claim

processor..


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Case studyon

HIPPA for Privacy, Security andConfidentiality of Health records


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HIPPA

The Health Insurance Portability and Accountability Act of 1996,

otherwise known as HIPAA, set forth new standards for the privacy

and security of protected health information (PHI)

The main purpose of this federal statute was to help consumers

maintain their insurance coverage, but it also includes a separate

set of provisions called Administrative Simplification. This section of

the act is aimed at improving the efficiency and effectiveness of thehealth care system .


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Administrative Simplification

The key components of Administrative Simplification include:

Standardized electronic transmission of common administrative and

financial transactions (such as billing and payments)

Unique health identifiers for individuals, employers, health plans,

and heath care providers

Privacy and security standards to protect the confidentiality and

integrity of individually identifiable health information


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Whom does HIPAA affect?

Anyone who uses health care or health insurance

Health insurers

Doctors

Hospitals

Employers who provide health insurance

Life insurers

Public health authorities

Billing agencies Information system vendors

Health service organizations


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What does HIPAA do?

HIPAA is a legislative act made up of these five titles:

Title I, "Health care access, portability and renewability," requires employers and

health plans to allow a new employee's medical insurance coverage to remaincontinuous without regard to pre-existing conditions.

Title II, "Preventing health care fraud and abuse; administrative simplification;medical liability reform," defines new requirements for privacy and security ofindividually identifiable patient information.

Title II, "Administrative simplification," , reduces the administrative component ofhealth care costs through the implementation of electronic data interchange (EDI)standards.

Title III, "Tax-related health provisions," standardizes the amount you can saveper person in a pre-tax medical savings account.

Title IV, "Application and enforcement of group health planrequirements," broadened information on insurance reform provisions and providesdetailed explanations.

Title V, "Revenue offsets," has regulations on how employers can deduct company-owned life insurance premiums for income tax purposes


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HIPAA- TERMS TO KNOW

Health Information (HI) - refers to information in ANY form (oral,

written, electronic) related to an individuals past, present, or future

physical or mental health, including the services delivered and the

method of payment.

Protected Health Information (PHI) - refers to any individually

identifiable health information (IIHI) that is transmitted or maintained in

any form.

Electronic Protected Health Information (EPHI) - refers to any

individually identifiable health information that exists in or is transmitted

in electronic form.


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WHAT IS IDENTIFIABLE INFORMATION

Names Addresses Employers Relatives' names Dates of birth

Telephone & faxnumbers

E-mail addresses Social Security

numbers Medical Record

numbers

Member/accountnumbers Certificate numbers

Finger prints Photos Codes Anothercharacteristics which

may be used to identifyan individual (forexample, occupation


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HIPPA And Privacy Rule

The Privacy Rule regulates the use and distribution of identifiable

health information and gives individuals the right to determine and

restrict access to their health information. Compliance with HIPAA'sprivacy regulations is required beginning April 14, 2003. Substantial

penalties, both civil and criminal, may be imposed for non-

compliance


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HIPAA AND PATIENT RIGHTS

HIPAA regulations give patients the right to:

Determine who can see and hear their personal health information(PHI).

Inspect their medical records and, for a reasonable fee, obtain copies

of those medical records if they want them. Restrict the use and release of information.

File complaints based on violation of privacy rights.

Exclude their names from patient directories.

Request confidential or alternative communication methods. Request a

list of when and where their confidential information was released


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HIPAA AND CONFIDENTIALITY

Confidentiality refers to an individuals right to expect that third

parties to which he or she gives personal information will thereafter

use that information only for the purposes for which it was given.

The physician's duty to maintain confidentiality means that a

physician may not disclose any medical information revealed by a

patient or discovered by a physician in connection with the treatment

of a patient


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HIPAA Security Rule

The HIPAA Security Rule mandates that reasonable and appropriate

technical, physical, and administrative safeguards be implemented

with electronic identifiable health information. We must ensure the

confidentiality, integrity, and availability of all electronic protectedhealth information we create, receive, maintain or transmit.

Compliance date for the Security Rule was October 16, 2003


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Information Security Standards for Protection of ePHI(Protected Health Information)

Information Security means to ensure the confidentiality, integrity,

and availability of information through safeguards.

Confidentiality that information will not be disclosed to

unauthorized individuals or processes

Integrity the condition of data or information that has not been

altered or destroyed in an unauthorized manner. Data from one system

is consistently and accurately transferred to other systems.

Availability the property that data or information is accessible anduseable upon demand by an authorized person.


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Conclusion

An Act such as HIPPA is not currently there in India which is an

impediment for enforcing electronic health record in India due to

issues of privacy and confidentiality therefore, Ministry of Health and

IRDA (Insurance Regulatory Development Authority) should takesteps to make an Act such as HIPPA for suiting requirements of

Indian Healthcare records.


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References

Yoo H.,Harner K.(2006) An Updated Survey of Health Care Claims Receipt and Processing

Times, retrieved May 15, 2012,from www.ahip.org/searchResullt.aspx

Ignagni, Karen M (2006)Market Analysis; Study shows electronic processing of health claims speeds payments, cuts costScience Letters

Loucks, Ron 2000 One step closer to a paperless world: new claims processing technology could mean the end of the paper-based prescription and insurance world Business And Economics , Health Facilities And Administration , 7(6),65

Bell, Allison (1998) Aetna to pay faster on electronic claims, 102 (25 ), 4,26

Cochran, John R, III (2004) Revenue Cycle Acceleration: Implementing Electronic Attachment ofClaims Documents( Health Facilities And Administration ), 19 (5)

Gambrill, David (2007). Driving efficiencies in auto insurance health care( Insurance ), 74 (5), 20

Larkin, Howard (2001). Claims in, approvals out--in seconds( Medical Sciences ), 78 (13 ), 28

Kristie Perry Dolan (1997),Speed up payments with electronic transmissions( Medical Sciences ),74 (21 ), 59

Loucks, Ron (2000), One step closer to a paperless world: new claims processing technologycould mean the end of the paper-based prescription and insurance world( Business AndEconomics , Health Facilities And Administration ), 7(6),65
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