From the MGMA Conference: Five Ways Reform Could Simplify Healthcare Administration

HealthLeaders Media Staff, October 13, 2009

The Medical Group Management Association has made administrative simplification one of the key goals of its healthcare reform advocacy, and several provisions in the reform bills currently being considered by Congress could save billions being wasted on administration if approved.

Changes that could alleviate administrative headaches include:

Machine readable patient ID cards. Nearly $2.2 billion related to clerical errors and waste could be avoided each year if the healthcare industry adopted machine-readable patient ID cards, William F. Jessee, MD, FACMPE, president and CEO of MGMA, claimed at the annual conference in Denver on Monday. MGMA has made ID cards a central focus with Project SwipeIT, which has gotten 1,000 pledges from insurers, providers, vendors, and other organizations to adopt the cards.

"I'd love to see Medicare lead the way on this," said Jessee. Being able to walk into a doctor's office and swipe a card to accurately provide insurance information was a "no brainer," he added. Currently the three healthcare reform bills under consideration in the House and Senate include provisions for adopting patient ID cards.

National health plan identifiers. CMS has already been authorized to move forward on national health plan identifiers, but has yet to take substantial action. All three healthcare reform bills would finalize the process for setting up the identifiers.

Electronic claims attachments. The current paper claims attachment process adds administrative time to the payment process and increases labor costs, Jessee said. Although the House healthcare reform bill includes a provision to establish rules allowing electronic claims attachment, neither bill in the Senate addresses the issue, according to Leah S. Cohen, MA, government affairs representative with MGMA.

Standard insurance operating rules. Most insurers have different operating rules for eligibility verification, claims processing, and other payment procedures. Standardizing the operating rules among all insurers has the potential to remove more than $40.4 billion in costs over 10 years from the system, said Jessee. All three healthcare reform bills currently have provisions that would move the standardization forward.

Real-time processing. The Senate Finance Committee bill and HR 3200 contain provisions that would allow real-time processing for eligibility verification and other steps of the payment process. This would save practices time and eliminate some unnecessary administrative headaches when managers need to verify whether a patient is eligible for coverage or to settle claims.

Although each simplification is being considered in at least one bill, it is still early in the process to determine whether they will make it to the final legislation. MGMA and other organizations are lobbying Congress to include administrative simplifications when the Senate bills are merged, and then during the conference committee to combine the final House and Senate legislation.

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