May 2013 Newsletter
Submitting Health and Dental Claims
Paper Versus Direct Billing Versus E-Claims Versus Mobile Apps
The submission of Health and Dental claims via mail seems to becoming obsolete due to technologies available with insurance companies.
The ability for dental clinics to direct bill to the insurance carrier has been around for years. Recently some insurance carriers are allowing vision care facilities to direct bill on vision claims and eye examination claims. The ability for certain paramedical practitioners (such as chiropractors, physiotherapists and massage therapists) to direct bill is also fairly new. Check with your Silverberg Account Manager to determine if the carrier of your Group Employee Benefits plan allows direct billing.
Employees also have the ability to electronically submit certain expenses online by registering with the insurance carrier. These expenses would include Drugs, Paramedical Practitioners, Eye Examinations, Vision and Dental.
The ‘latest and greatest’ is the ability to take a picture of your claim with your cell phone and submit the claim via your phone to the insurance carrier. Use of mobile apps has already changed the way we shop and consume content. It is now going to change the way people interact with insurance companies.
Insurance companies recognize the importance of IT and mobile and are allocating healthy budgets to take action.
Here are two ways mobile technology is advantageous to employees:
1. Streamline the claim process
In today’s time-starved society, no one likes filing a claim so with mobile technology, filing a claim is simple, quick and efficient. After incurring an expense, the employee takes a picture of the receipt with their cell phone and and the app downloads the receipt directly to the insurance carrier.
2. Promote health and well-being
An insurance company mobile app can be used to encourage health and wellness of insurance consumers, such as recommending an app to decrease stress or recommend a monitoring app (such as Glooko) to track sugar intake for diabetics. Similarly, insurance companies can now track which healthcare providers are recommended by users, and which ones are most visited. In turn, they can also recommend popular healthcare providers or highly-rated ones; in essence, this app serves as the hub that connects healthcare providers, insurance companies, and patients.
5 Ways Mobile Apps Will Transform Healthcare
Earlier this year Kaiser Permanente leapfrogged the industry when it made its entire electronic health care system – the most extensive electronic medical record offering in the world – available to its 9 million members via an Android app. The country’s largest medical organization quickly announced that the app had garnered more than 95,000 downloads. Kaiser patients now make appointments, check lab tests, order medicines, and communicate with their physicians from the palm of their hands. CEO George Halvorson asserted that accessing health information on mobile devices is becoming the “new norm.” The numbers support Halvorson’s prediction. Global sales of smartphones are expected to hit 1.5 billion units by 2016. Ten years from now everyone from teens to the elderly will be carrying a smartphone, and these mobile devices will be exponentially smarter than they are today. In addition to being location aware, the smartphone of the future will be situationally and contextually aware. This will allow it to present information directly to you when you need it, revolutionizing the way patients are engaged by the healthcare system.
These new capabilities coupled with the explosive growth in digital health apps – the market for mobile health apps is expected to quadruple to $400 million by 2016, according to ABI Research – promise to radically change the way health care is delivered and accessed. Doctors won’t go away, but they will have a lot more information about you and your health, and it will stream in from more sources than ever before. For healthcare delivery, we’re rapidly moving from a world of inbound patients to a world of inbound data. The impact of this shift on the healthcare system and how consumers use and act on health information should not be underestimated.
Here are five ways digital apps and smartphones will transform healthcare:
• Improved access to care:
In a digital age, the requirement for patients and doctors to be in the same location is eliminated. Patients suffering from chronic diseases who live in rural areas or otherwise have limited access to doctors will be able to “visit” with primary care physicians or specialists located in the next major city or a half a world away. Increasingly, the patient will be in his or her home. Instead of having the government or insurance companies dictate that a visit must be in person, which may be either unnecessary or dangerous (for frail elderly patients), patients and physicians will decide together when a visit is best done live and when healthcare services can be delivered virtually.
• Improved patient engagement:
Many aspects of healthcare discourage patient engagement – long lines, complexity, lack of transparency of cost and quality. Much of this is unnecessary. Why should accessing healthcare require a painstaking wait in the physician’s office? You could easily be notified via text that your physician is running late. Apps can also eliminate complexity. Imagine you are using a medication reminder app that knows how many pills you have taken and when you will take them next. It “knows” you are running low on pills and it automatically asks whether you want to pick up your prescription at the nearest Walgreen’s (because it “knows” your location and where your prescription is on file) or would prefer it mailed to your home. One simple answer and it automatically places the prescription for your chosen delivery method and charges your HSA.
• New provider business models:
The explosion of inbound data from sensors and devices will create new opportunities for healthcare professionals. Today’s healthcare services and business models are ill-suited to a system dominated by an influx of patient data. Expect the need to manage inbound data to create a new set of companies focused on data management. Large call centers will house nurses, doctors, pharmacists and other healthcare professionals who watch, manage and respond to this inbound data. In addition, digital health apps will allow providers to effectively manage and coordinate patient care in a complex environment. This will be critical as the government and insurance companies increasingly “bundle” payments and determine other ways to shift risk to providers.
• Reduced Medicare Fraud:
My experience is that Medicare is terrified of an explosion of costs that could result from digital interactions, primarily due to the increased patient access to care. However, the more impactful consequence of digital health will be in reducing fraud, currently estimated to drain about $60 billion annually from Medicare. One simple reason is that digital apps have an amazing ability to track people and transactions in space and time. In the future, digital apps will allow Medicare to correlate claims data with location, and time data from the digital health apps to look for fraud. Imagine visiting a pharmacy – one of the most common locations for Medicare fraud – scanning in your Medicare card and conducting your purchase digitally. An app would allow Medicare to instantly trace that transaction. Hotspots of activity could be identified and investigated in real-time rather than months after the money is in the criminal’s offshore bank account.
• Improved Patient Safety:
Digital apps will make health care safer by giving patients tools to manage their own health. Today, patients leave the hospital with a stack of papers and very little memory of what they’re supposed to do when they arrive home. Imagine if all the information you needed for a safe and healthy recovery were handed to you on an app. You could tend to the most urgent tasks and the one or two items most important to remember – and the app would take care of the rest. Apps can remind you to take pills, monitor side effects and transfer the knowledge to your provider. This would be a huge advance for patient safety.
In the future, everything that can be done digitally will be done digitally. Digital health apps will schedule appointments, tell you the doctor is running late, help monitor medications’ side effects, and help you follow your care plan accurately. These changes will engage patients with their health and healthcare in new ways. It will also radically reform healthcare delivery.
Source: Forbes.com – by Derek Newell