March 2008

Policing Your Commercial Payments

The March 2008 issue of the Healthcare Financial Management Association's (HFMA) hfm contains an article by Health Check's President, Marc Mertz.

The article highlights steps that a hospital can take to help reduce and recover underpayments from managed care companies. Solutions include contract management systems, internal auditing departments, appeals processing, and yes, outsourced managed care auditing firms.

If you do not already receive hfm, you can read the article on our website.

UnitedHealth Group has partnered with ICICI Lombard, India's largest private general insurance company and second-largest health insurer, to provide ICICI Lombard's 1.6 million policyholders traveling to the United States who are covered by the insurer's Overseas Travel Insurance or Student Overseas Medical Insurance will have access to UnitedHealthcare's Options preferred provider network.

According to Sudhir Menon, Head, Travel Insurance, ICICI Lombard, "This partnership is an innovative benefit for Indians who are increasingly traveling abroad for both occupational and educational purposes. We are committed to continuously enhancing our service and value proposition, and we look forward to leveraging the assets of UnitedHealth Group to deliver the best in service and resources to our customers throughout their travels to the United States."

UnitedHealth International CEO, Ori Karev, states, "Our new partnership with ICICI Lombard is an important step in making access to cross-border health care more seamless for consumers, a model we are exploring in multiple markets. ICICI Lombard is an outstanding partner committed to enhancing the quality and access to health care for its members. We believe Indians traveling overseas will have peace of mind knowing that, when they visit the U.S., their health care needs will be met."

Partnerships like UnitedHealth Group and ICICI Lombard are just one example of the increasing global healthcare market in which foreign health insurance companies are offering access to services while traveling in the United States.

If you are a contracted provider with UHC, however, you need to carefully review your contract to determine if it requires you to offer ICICI Lombard, or other plans like them, the same discount that you allow UHC. Was the contracted discount intended just for UHC, or also for its affiliates? And which UHC plans are allowed to access the contract- HMOs? PPOs? Even indemnity plans?

To reduce the volume of payors accessing inappropriate or unwarranted discounts, all of your hospital's managed care contracts should clearly state specifically which plans are eligible to access the terms and rates in the agreement.

Hospitals Give Insurance Companies Low Marks

A recent survey of more than 500 US hospitals yielded results that were not surprising, especially if you deal with managed care companies on a regular basis. The survey was commissioned by Davies Public Affairs.

According to the survey, three of the five largest national insurance companies received unfavorable ratings from hospital executives. UnitedHealthcare, the nation's largest managed care company, received the lowest rating. Their 8% "favorable" rating made President Bush's or Congress' approval rating look stellar. An overwhelming 91% of executives rated UHC "unfavorable." UHC consistently ranked as the worse insurance plan according to this survey.

WellPoint was the second worse-rated plan, with a 48% unfavorable rating and 20% favorable. Cigna performed slightly better at 47% unfavorable and 44% favorable. Of the top five plans, Aetna rated higest with a 57% favorable score, and 37% unfavorable.

The surveyed executives used words such as "negative, greedy, difficult, rigid, arrogant, cheap, incompetent, and unresponsive" to describe the plans.

In a healthcare system where hospitals are constantly being rated on quality, many may see these results as backlash against the payors that are frequently providing the ratings. But these results reflect the level of frustration felt by hospitals nationwide. Every stage of the hospital/insurance company relationship is contentious- from contract negotiations, to claims processing, to reimbursement levels.

Health Check Redesigns Internal System

In an effort to better serve its clients, Health Check has been undergoing a complete redesign of its internal account management system. Health Check continues to embrace technology to reduce or eliminate routine and time-consuming administrative tasks, allowing us more time to identify and recover underpayments on your behalf.

Health Check has partnered with TreadPath, a Raleigh-based software design and engineering firm, for this ambitious project. TreadPath was chosen for their experience designing HIPAA-compliant applications and their strong database design knowledge.

This project will have no impact on clients, but will allow Health Check to continue performing its unique line-by-line auditing process in a more efficient manner. Health Check does not rely on payment calculators or other software to identify underpayments. Our trained and experienced team of auditors review every account that we receive from our clients, and are able to identify underpayments that systems typically miss. You can learn more about our auditing methods at our website www.hcaudit.com.

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