Health costs could rise because Government ignored us
Government reforms for health insurance claims regulation explicitly disregarded recommendations, and could drive up the cost of treatment, according to a physician and advisor.
Femi Bada, a physician from the 15-member implementation committee that advised Government on how to modernise the claims procedure, said Government should have allowed a deadline of years not until August 1 for providers to develop electronic information systems.
“Upfront payment was the last thing we needed to tackle,” he said. “We need to put in place electronic billing and payments before legislating against upfront payment. Providers cannot set up any electronic system until the insurance companies do, because if we invest in a system different to what the insurance companies choose, that investment will be a failure.”
He added: “I want to emphasise that upfront payment was a reaction to the slow payment from GHI and HIP; these delays were scandalous, for example, getting paid five years after providing a service. The private insurers have been vilified by this legislation.”
Dr Bada said he was “astounded” to be told last week of the August 1 deadline.
“We felt like we were simply being used to give the Government a semblance of having gone out and explored all avenues,” he said. “Why give advice when you know they’ve already made up their minds?”
The 15 members of the committee met each week from January until March 15, he said.
“We came to the Bermuda Health Council and told them we needed to do it in stages,” Dr Bada said. The cost of computer systems and programmes for electronic submission are high, he added, quoting a figure of $16,000 for a computer purchased for his own practice. Software can also run into thousands, requiring training and maintenance costs.
“We need computers on all sides to be able to talk to one another,” he said. “The insurance companies will have to invest, but probably not as much as the private doctors, who range from people just starting out in their practice to older doctors about to retire. They range from people who are computer literate to people who don’t want to know anything about them. And they range from group practices to single practitioners.”
The new regulations will outlaw providers from charging patients upfront for the insured portion of treatment. They also require insurers and providers to communicate electronically, with insurers paying on claims within 30 days. The legislation gives the BHC the power to fine offenders.
The question, Dr Bada said, was: “Why the rush? And why legislation? Why make it an offence?”
Having been an inaugural member of the BHC, the physician asked why an organisation intended as an industry watchdog was being made into “a statutory body that takes over discipline”.
Dr Bada also accused Government insurance agencies such as HIP and GHI of being “the worst offenders” in taking too long to pay.
“The Government ought to be magnanimous enough to accept that their agencies have also been the worst offender, whose tardiness had led to many providers having to institute this upfront payment. Healthcare providers should not be singled out as money-grabbing ogres with scant regards to the welfare of the Bermudian public. There are many providers who provide pro bono care for this public.”
Another provider, who declined to be named for this article, commended GHI for paying out more quickly today, but agreed that HIP “has not historically paid on time”.
Upfront payments, he said, are a form of “inherent fee regulation”, by keeping the cost of treatment prominent.
“The reality is that we all want to minimise upfront payments,” he said, “but we want to do it in the manner that will cause the least disturbance to the system, and the least inconvenience to patients.”
The view of the majority of stakeholders, he said, was that it would take “a couple of years” to eliminate upfront payments, with an electronic system already in place.
Asked if he thought the August 1 deadline of legislation approved in the House of Assembly was physically possible for Bermuda’s industry, he said: “Nobody knows. There are many ways to submit claims and each has different levels of complexity. Is this new deadline doable? Maybe not.”
Two of the Island’s top insurers responded positively to reforms in healthcare payments but acknowledged that it brings difficulties.
A spokesman for BF&M called the August 1 deadline “challenging”, but said the company was committed to implementing the new system on time, and already had a web-based system to check insurance eligibility and coverage.
“BF&M supports this important initiative in principle and believes that every person should have equal access to healthcare. It’s important that a project of this magnitude has a comprehensive and well developed implementation strategy.”
Meanwhile, a spokeswoman for Colonial Insurance anticipated no difficulties for the company.
“In fact, we already are accepting claims electronically from medical, dental, pharmacy and hospital providers. We also have given providers the ability to file claims directly to Colonial through a secure web site for those that do not have billing software systems in place.”
However, she added: “From the providers’ perspective, many of them will not just have to make an investment in their technology, but will also have to train staff to be able to complete claims data files with relevant medical coding related to diagnostic and procedure data. This will cause a hardship on many of the smaller healthcare practices.
Forcing electronic payments through without adequate preparation and training may result in disarray in the system as claims files may be incomplete, or not have correct or relevant data resulting in slow claims payments or denials.
“Also, as far as we can see, this legislation does not apply to providers who file paper claims, so we may see more providers returning to filing paper claims, which would defeat the purpose of the exercise.”
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