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