RFID fixes charge capture problems in hospital operating rooms: we need to see Goldilocks

The health insurance industry is fraught with problems from end to end. The industry has a lot of checks and balances against inaccurate charge claims by hospitals. This has been built up over a 50 year period so that (a) insurance providers can catch errors and (b) the insurance industry can cut costs by denying claims.

In an operating room setting, 40+ percent of a claim comes just from implants and supplies alone. The average hospital typically has a one size fits all charge for the lower cost supplies (they may also bill that as part of the OR room charge). But the real cost of supplies in in implants (hips, knees, stents, heart valves, etc). Hospitals use extremely manual processes to charge for the expensive implants : often taking stickers off of product, placing on to a charge sheet and after the case typing these into a billing system.

This leads to tremendous error: about 15-20% of supplies and implants billed in the OR are incorrect. This can be as minor as getting the size of an implant wrong to as major as not billing for a stent or billing for too many stents. The reason has nothing to do with any incompetency by people working in the OR (on the contrary, these are highly trained, skilled and smart people). The problem is the OR is a high stress environment (we call it the 'Warzone' of the hospital) and manual systems break. Imagine trying to scan a barcode or peel a sticker off a stent in the middle of the case with a patient coding and a doc yelling!

The hospitals and patients come out on the losing end of this system. If too much is billed, the health insurance industry has many checks and balances in place to catch and deny the claim - costing the hospital and patient months of paperwork to correct and refile. Insurance companies live in plush office buildings, not a stressful hospital, so this is easy for them. If the hospital misses a stent and doesn't charge for it, the health insurance provider's cost is reduced by $2,000, so they won't correct it. The hospital just lost $2,000 and the information about the implant is not on the patient record.

Mobile Aspects' RFID systems ensure accurate, reliable, real time information when it comes to these supplies and devices. In the OR environment, staff simply scan the barcode of the patient before a case starts. Anything then removed from our shelf is automatically captured and sent to the billing system. If any devices are not used, it is simply placed back on our shelves and the charge is credited in real time. This leads to Goldilocks charge capture: not too much, not too little, but just right (and just right every time). And when 40% of the case cost is implants and supplies in the OR, we better all ensure we get it just right.

From The New York Times:

DIGITAL DOMAIN: See You in 6 Months. And Your Insurer Is O.K. With the Bill.

Instant electronic processing of medical insurance claims has long been discussed, but its adoption has been slow.

http://nyti.ms/cfxRUs

Posted via email from Suneil Mandava's Posterous