Would a single health claims processing system help the health system???

[mwooldri]

Now I am not talking about universal health coverage, which I think would be a good thing for this country. What I am talking about is a single system that processes medical insurance claims.

Right now, there is a good number of health insurance companies, all with their separate claims processing system. Health service providers have to liaise through different health insurance companies to get claims processed (in difficult cases).

Even if we can't nationalize the money side, couldn't a partial nationalization be done? Health service providers would deal with only one point of contact, the National Health Billing Company (NHBC). The NHBC would collect co-pays and liaise between all the health care providers and the various insurance companies that exist, including medicare and medicaid. Health service providers would then be able to bill for the actual cost of the healthcare, without putting in a mark-up for bad debts.

It doesn't mean that there would be universal healthcare coverage, but it would mean that people can go to a doctor if they don't have healthcare coverage, and at the point of delivery no cash would need to be given. The services would of course need to be paid for, but people wouldn't not have to go to the doctor because they couldn't pay there and then. Of course if it was a major trauma and the bill was quite large, then although the hospital would get paid the patient would most likely have to file some form of bankruptcy once they get out of hospital (or worse; whilst in hospital).

This would then make the introduction of a national health insurance scheme easier, and yet it would allow private health care providers to still compete because the consumer could choose to go with an employer sponsored health plan, a self-paid health plan, or a governmental health plan if they qualify.

Just my silly ideas, and yes before you ask I would prefer a true universal healthcare system. However the only way I think it would happen is if it were to be put in place incrementally.

Thanks for your thoughts,

Mark.

[ayeshahaqqiqa]

1. When Dean suggested that all the numbers

used to describe procedures be made the same (veinapuncture would always be #11111, for example, no matter whether filing for Medicare, Medicaid, private insurance, or whatever), and the folks at my doctor's office said that would save a lot of time and keep them from making mistakes.

[napi21]

2. I was going to remind everyone of that! Dean proposed

standardizing the coding on claims way back when he began his campaign for Pres. I heard nothing but positive responses from anyone in the medical community!

Wonder what ever happened to that idea?

[ayeshahaqqiqa]

4. I don't know,

but the secretary and nurse at the doctor's office were really disappointed when nothing came of it.

[Seansky]

3. that sounds way easier than it would be.

If a single state hasn't really been able to effectively centralize a single database for, say, Children Health Plan, without major, major delays and over budget, I doubt a national platform would come close to ever being implemented. I could tell you of hundreds of med. and large (multinational) corporations that have failed or being successful at deploying integrated platforms. Doing so for the health care arena would require integrating so many different organizations that the concept just sounds horrendous...Unfortunatelly...particularly with the qualification requirements that the available coverage programs have...

[Sgent]

5. The other side of HIPPA

has essentially made filing claims MUCH easier -- standardizing coding (Dean's Plan), etc. After full implementation of the HIPAA codeset and electronic transaction standards, it should be much easier to file claims.

[BJW]

6. Good idea--but it interferes

with routine delayed and denied billing practices that are SOP for the health insurers--which practices add to their excessive profits.

I imagine it'd meet some extremely stiff opposition.

I'd like to see this as a Dem platform, but also would like to see thought given to the reactions of the insurance companies and their supporters, and come up with responsive memes to effectively counter their opposition.

[bemildred]

7. The present non-system is so egregiously bad, that even random change

might well offer some improvement. Not to mention what might
be possible if some "intelligent designer" were to work actively
to increase order in the system.

[philb]

8. If it was well run and fairly administered it would save a lot of money

and provide a more efficient system. The problem is getting good
people appointed, having a rational system of whats covered, keeping politics and special interest from dominating the system.