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Health + Tech | Health technology that simplifies billing and collection

Doug Halsall, Chairman and CEO, Advanced Integrated Systems

Health technology is becoming a more mainstream part of healthcare in many parts of the world, and locally we have started to make headway in the use of electronic forms of healthcare access and delivery. There is a lot that can be done with technology in the healthcare sector, but when we think of health technology, we often think of the medical and other patient-care functions that technology can make more efficient and accessible.

We also think of electronic medical records (EMR) and remote care. We often do not include the administrative functions in health technology, although there are many in this area that can improve the overall management of facilities.

We can agree that no business can be sustained without financial input and the maintenance of profitability. In order to do this, efficient billing and timely collection is important. This is one of the administrative functions that has to be a part of the health ecosystem to complete the process, and that can be facilitated through a holistic health technology software. The major way that many facilities make money in a medical facility, especially the private practices, is through fees buffered by health insurance.

In the past, this came with risks. As you know, insurance allotments can be exhausted, and if a facility has to wait weeks after submitting a paper claim to learn the status of it, the likelihood of those fees not being paid is great. This is because essentially, the service has already been given and the patient would no longer be available for billing outside of the uncollected insurance.

The solution to this problem lies in the digitisation of the process of insurance collection. Online, real-time insurance adjudication has simplified insurance billing and collection. This can be embedded in the hospital information management system and used in the overall billing management process for a hospital or a smaller private practice.

It is simple: Providers – doctor, dentist, ophthalmologist, radiologist/lab, hospital, etc. – can submit claims online in real time by swiping the patient’s health insurance card. This is quick and immediate, which improves efficiency for the health insurance companies and providers and increases access and convenience for patients.

It also solves the problem of having to wait for weeks to know whether a patient has exhausted his/her insurance allotment and what specific services are covered by his/her insurance. A receipt can be provided immediately and the system gives an immediate response, ensuring that the patient and the provider benefit by always accessing his/her payments, which are guaranteed.

The other aspects of billing and collection can also be incorporated in the hospital information management software. Fees collected outside of insurance and those exchanged for the acquisition of goods and services can be managed through accounting software that can be incorporated in two ways. There are systems that come with this software already integrated as a module and there are those that can be linked through interoperability.

Interoperability is a recognised standard in the healthcare sector and is often an important consideration when acquiring software. One much used standard that facilitates interface and therefore interoperability is Health Level 7 (HL7). These are international standards related to the sharing of health and administrative information across various platforms and devices. HL7 compatible devices can communicate with each other, which is what makes them interoperable.

An institution such as a hospital usually has several functions and various computer systems to organise those functions. If all their computer systems are HL7 compatible, for example, then they can seamlessly link operations like inventory, registration, laboratory, electronic health records and, as we have been discussing, accounting, billing and reconciliation functions.

Jamaica has come a far way in terms of technology acceptance in the healthcare sector. I am pleased to see that we have leaned on technology to assist us through this pandemic and we are making inroads in interweaving various technology products in our health offerings.

This is the way to go in today’s world to facilitate broader access and more efficient care continuity. We will enjoy the benefits of these decisions for generations to come.

Doug Halsall is chairman and CEO of Advanced Integrated Systems. Email feedback to doug.halsall@gmail.com and columns@gleanerjm.com

Published: Saturday | September 18, 2021 | 12:09 AM