![]() Luckily, through the Affordable Care Act and the administrative simplification that was put forth many years ago, the black box of where a particular patient is in meeting their deductible, the balance remaining, their max out-of-pocket, and the plan design data are easier for companies like us to access. On top of that, we need to know how that affects a particular patient at a particular point in time. Technology now has been able to bring in and codify all of that information. ![]() The second is to be able to set up the right kind of rules to say, for example, that if you had a surgery and multiple procedures were done, how does that affect the reimbursement in terms of what the provider would get paid? These were rules that were here before in a black box, where nobody quite knew except the super specialist in billing. The first part of a triangulation that we do within our platform is to know what the contracted fee schedule is with a particular provider across the different insurance companies. From a technology standpoint, providers have often struggled to have the right type of technology that enables them - as they become in-network with various insurance companies - what that contracted rate is. The No Surprises Act is the next evolution of regulatory intervention by both state and federal government to avoid surprise billing and to make sure there is advanced notice for the consumer in terms of what their out-of-pocket is going to be. Solving that in a way that educates the consumer and enables price transparency so that there are no surprises later is a big part of the transformation that we as Health IPass and Sphere have brought to healthcare consumer engagement.ĭoes that inability to tell patients what they will owe upfront limit their willingness to leave their credit card information on file as they do in almost every other industry? The third generation is to take it one more level in solving the key issue in healthcare, which is that the consumer doesn’t know what things cost and the merchant - the healthcare provider - literally has no guarantee that they’ll ever get paid. It’s enabling that workflow to occur any time well in advance, on any device, with the right kind of smarts embedded into it. It’s not just about replacing the electronic clipboard. ![]() We’ve always focused on predictive analytics way beyond just the data capture, how that can streamline the billing process and ultimately make that experience good for both the consumer as well the healthcare provider.Īs patients become a significant source of revenue for provider because of health plans with high deductibles, there’s a real pain around collecting patient responsible dollars in a streamlined, easy manner that both educates the consumer as well as makes it easy for that transaction to occur. That type of innovation was a second generation. Being able to read information and ensure that we’ve got a good capture, just like your banking apps do when you scan a check, for example. Baked in there were some really cool innovations, such as enabling the patient to take a picture of their driver’s license to validate their identity or to take a photo of their insurance card. The second generation of the evolution focuses not just on doing it in the clinic, but enabling people to do it on any device, any time, with a mobile-first kind of a strategy. The more you enable patients to be able to do it in advance, the better. We’ve always believed that’s just a starting point. ![]() Maybe a kiosk, maybe a tablet, and having folks, when they come into the clinic, be able to use electronic mechanisms in terms of the data capture. To what degree is healthcare still using clipboards and badly designed paper forms instead of electronic systems for collecting check-in and billing information?Īs we look at how the industry has evolved, the first generation of solutions effectively came up with electronic ways to change these forms from paper-based to an electronic clipboard. ![]() We are all about taking friction out of the payment process through an integrated solution that meets the needs of large health systems all the way to the smallest of the healthcare practices. Sphere is a payments company that, across multiple industries, streamlines the payment process for consumers and in healthcare in particular. Rajesh Voddiraju, MS is founder and group president of Health IPass, a Sphere Company of Oak Brook, IL. ![]()
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