The Green Sheet Online Edition
January 28, 2008 • Issue 08:01:02
Ensure health care claims at the POS
According to Memphis, Tenn.-based ISO Impact PaySystem, more than 25% of all health care insurance claims are denied when first presented for payment, a collection problem no other industry faces. Denied claims cause headaches for everyone, from useless paper-pushing to wasted time because nobody gets paid.
Impact PaySystem is offering a solution with ImpactMD, an online health insurance eligibility portal designed to assist health care providers with the means to electronically determine a patient's insurance eligibility within seconds, compared to the typical 18 to 25 minutes.
The claims submission process is a "one-click" electronic solution. Once eligibility is determined, claims can be submitted error-free, and providers can be paid in real-time at the POS.
Impact PaySystem said about 6% of all health care claims are denied due to patient ineligibility under a given insurance plan. More than half of the money from those denied claims is ever reimbursed to providers, resulting in substantial financial losses.
ImpactMD minimizes or eliminates that loss by allowing the provider to use any Web browser to log on to ImpactMD's eligibility portal to ascertain whether that patient is covered for a particular medical procedure. Payer information is decoded into English, and an entire patient schedule can be processed within minutes.
As part of the ImpactMD system, the ClaimEditor uses payer-specific edits to ensure the claim is paid on first presentation, nearly eliminating claims resubmissions.
Based on CCI (Computer to Computer Integration), LMRP (Local Medical Review Policy) and medical necessity edits, the ClaimEditor identifies every reason a claims file may not be paid. Published and unpublished payer-specific criteria updated weekly may also be utilized to that end.
Impact PaySystem said ImpactMD's all-payer rules engine gives providers a 100% payment rate for reimbursements on first submission, minimizes receivables and days outstanding by up to 20%, speeds up revenue collection, and reduces denial management costs.
Impact PaySystem worked for over a year with insurance providers conducting beta tests to develop ImpactMD. It is available in two customized interfaces for hospitals and physicians.
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