MedCurrent tackles front end of insurance verification

A new start-up company is bringing to market software that tackles the thorny issue of patient insurance verification. MedCurrent is taking a different approach to the process, offering a service that vets patients' insurance status prior to imaging studies being performed, rather than after the fact.

April 6, 2009 -

Insurance eligibility is a nettlesome problem in healthcare, with 25% to 30% of insurance claims denied on the first pass, according to Dr. Stephen Herman, president of the Los Angeles company. The economic slowdown is exacerbating the situation as many people lose their jobs -- and their health insurance -- or as employers change their insurance carriers in response to rising premiums.

"With healthcare costs going up, employers are changing coverage quickly. The employer may have changed the plan, but the employee doesn't know that," Herman said. "Our system runs a check of what the patient claims is their carrier -- the patient could be innocent [of their noncovered status] but still not have coverage."

Imaging facilities can rework and resubmit denied claims, but that involves considerable staff resources and can delay cash flow, an important consideration in an area of economic recession and lower reimbursement due to the Deficit Reduction Act (DRA) of 2005. MedCurrent believes that it can fix in advance up to one-third of studies that might otherwise be denied.

The company's MedCurrent Verify software is a standalone, downloadable Windows application that works by presenting imaging facilities with a computerized form with several fields of patient data to fill out. After the form is submitted, users get a report within seconds detailing the patient's insurance eligibility.

Herman said that Verify includes links to eligibility data for some 350 insurance carriers. Verify users find that using a single interface for all eligibility checks is more efficient than having to contact every insurance carrier over the phone or via a Web site, he said. The company offers the software on a per-transaction basis, with pricing dependent on volume but in the range of 40¢ to 50¢ per transaction.

MedCurrent's Verify software provides a single-screen interface to more than 350 insurance providers. Image courtesy of MedCurrent.

MedCurrent began shipping the software in fall 2008, and its first end-user installation was Pueblo Radiology, a 22-physician radiology group in Santa Barbara, CA, with four imaging centers performing more than 65,000 procedures annually at their Santa Barbara and Ventura locations.

Since last fall, Pueblo estimates that it has collected approximately $115,000 per month for the first three months of 2009 from patients at the time of service based upon information from Verify. The software has also improved the group's cash flow and reduced the need for billing and collection activity following patient visits.

MedCurrent also offers Verify as a toolkit that enables the application to be embedded within RIS software. The company has already completed integration with one RIS software product, and the firm is fielding interest from a number of other vendors, Herman said.

Herman pointed out that MedCurrent's software does not perform preauthorization, currently a controversial topic given the rise of radiology benefits management firms.

Herman is a radiologist who has also had an interest in healthcare information technology, and he was the founder of Interpra Medical Imaging Network, which developed software tools for radiologist productivity. Interpra was acquired by Merge Healthcare of Milwaukee in 1999, and Herman subsequently served as Merge's chief medical officer for four years.

He believes his experience at Merge helped him understand the particular issues faced by smaller hospitals and imaging centers, and how PACS, RIS, and other tools can help them solve their problems. MedCurrent recognized early on the billing problems that many centers face, so they decided to focus on the paper flow between imaging centers and insurance providers.

MedCurrent believes that Verify fits within the current environment in which facilities are looking to healthcare IT to operate more efficiently and improve the quality of care.

"With the DRA, it's more important than ever for centers to watch their bottom line," Herman said. "If they have to spend money doing rework due to denials, that costs money and affects their bottom line. The current economic climate is calling out for these sorts of tools."

 — Brian Casey

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