How futuristic is it to believe that one swipe of a debit card would reveal your identity, your health record, and your health plan coverage and eligibility information? Not as far off as you think.
According to HealthLeaders-InterStudy, a leading provider of managed care and healthcare market intelligence, insurers and payment processors are building technology systems to link banks, payors, providers and consumers. The ultimate goal is a smart debit card that will carry all the information needed to make a healthcare purchasing transaction transparent, efficient and seamless.
"With an estimated 6 million Americans participating in consumer-driven healthcare, the need is growing for a consumer 'smart' card," states Chris Lewis, HealthLeaders-InterStudy research analyst. "However, achieving widespread use within providers' offices will pose the most direct challenge."
The majority of health accounts do have debit cards tied to flexible spending accounts and health reimbursement arrangements, which are set up and controlled by employers to pay for employees' qualified medical expenses. Industry observers say the more recent adoption of health savings accounts, which are tied to high-deductible health insurance plans, will further propel debit card use. However, most systems do not feature instant processing and approval of a health insurance claim -- and without that "real-time claims adjudication" feature, most health purchases cannot be as simple as a department-store purchase.
A few large insurers are making progress. Humana Inc. has launched a successful real-time claims adjudication system in six medical practice sites so that physicians' offices can be paid in a matter of seconds. This four-month pilot project enabled the clinic staff at MacGregor Medical Center in San Antonio, Texas, to get a claim back from the insurer so the bill could be presented to the patient on the spot.
UnitedHealth Group is unveiling an integrated ID and debit card that will store members' identification, eligibility status, and health records. Using a card reader connected to the provider's computer via a standard USB port, the provider can then call up the patient's information on the UnitedHealthCareOnline provider portal. This system would enable a claim to be submitted, and within 10 seconds the provider would know the reimbursement and how much the patient would owe.
There are several factors that would further complicate instant pricing and payment. Many physician practices commonly deal with 15 or more payors with varying product lines. For multi-coded services, prices and payment rules vary widely among insurers. With a thousand or so practice management software programs currently in use around the country, it will be difficult to design a card "smart" enough to work with them all.
For providers, the shift to smart cards will depend greatly on how many of their patients have these cards, and whether the benefits in speedier claims payment outweigh the costs of the technology.
As medical debit cards get smarter and insurers begin more widespread implementation, these cards will become the electronic links to bank accounts
to facilitators of instant member identification, insurance eligibility, and claims adjudication.
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