HSE set to tackle issue of consultants’ insurance forms

The HSE is introducing measures to ensure that consultants sign health-insurance claim forms as quickly as they should, writes Gary Culliton

The Health Service Executive is introducing incentives for consultants to sign their insurance claim forms on a timely basis, along with a major crackdown on those consultants who do not, IMT has learned.
The HSE has secured agreement with the major health-insurance providers for the signing off of claims by a secondary consultant clinician (in six pilot sites) where the primary consultant has failed, for whatever reason, to sign off in a timely manner.
This pilot was up for review in April 2010 and the HSE is now extending it to a further six sites. Specifically, the HSE is now considering the possibility of directly billing patients in cases where the consultant has not signed the claim form within 30 days after discharge. It is also considering possible limitations on admission rights, if there is no improvement over time.
Following a request from Health Minister Mary Harney, Vhi Healthcare paid an advance of €50 million in respect of private insurance-claim income that was owed to the HSE. This payment was made in November 2009 and was money that was due to be paid to the Executive in any event over the year, and which the Vhi agreed to advance, as requested.
As part of the agreement, the HSE has now said it was always the case that the Vhi would deduct the advance from each hospital, from the claims received, over a five-month period running from last Wednesday, June 30, until later this year — November 30.
Budget sanctions
To counter the effect of this deduction of the advance, the HSE has taken steps to accelerate cash collection. Hospital managers have been instructed by senior management to reduce their debtor period to 60 days initially and budget sanctions will be imposed on managers who fail to reach this target in 2010. The HSE’s ultimate target in this regard is to move to 30 days. Targets for income for all hospitals in 2010 will be based upon a reduced number of days and this will be implemented through the budgeting process.
A concentration of effort on private insurance income collection as the largest single area of patient debt has been ordered by the HSE Chief Executive, Prof Brendan Drumm. The focus at individual hospital level on the issue will be concentrated on the following up of private insurance claims that have been submitted already, but not yet settled.
Any outstanding queries are to be addressed as a matter of urgency. Hospitals must in future compile and clear any outstanding claims that are awaiting submission to the health insurer.
Hospital CEOs and finance managers/accountants have been reminded of the importance of addressing outstanding private insurance payments and all other outstanding debt, the HSE said. Clinical directors are being asked to assist, as necessary, in addressing difficulties that may arise at individual consultant level.
This initiative resulted in a number of improvements already in 2009. An additional €30.8 million claims approximately were submitted between 23 October and 16 December last year. Cash received in the final quarter of 2009 was approximately €22.3 million higher than average for the previous three quarters of the year.
A high-level group, with representatives from HSE Finance and voluntary hospitals, continues to negotiate with the private insurance providers on business processes and the reduction of debtor days. The aim is to streamline transaction processing and data exchange. Parameters for private and semi-private charges by public hospitals, both voluntary and statutory, will be set. Billing and payment methods and the implications of the new consultant contract are being considered. The level of debt, administration of private-insurance claims process and service-level agreements are all being discussed.
The ultimate focus of the high-level group is to formulate a national service level agreement with private insurers, to streamline agreed business terms and ensure payment of hospital accommodation bills within 30 days. This agreement is currently in draft format and under discussion.
Negotiations are ongoing with insurance providers to implement electronic exchange of data to speed up the claims and payment process. The HSE is working with the Departments of Health and Finance with a view to implementing electronic submission of claims data in the larger voluntary and HSE hospitals, in the first instance.
HSE billing system
Approval has been obtained from both these Departments to commence the centralisation of the entire HSE billing system, which will streamline this process and focus attention on collecting all outstanding debts. Tender documents for this project are being prepared.
The HSE is working with the Department of Health and Children with a view to implementing flexibility in the private-bed designation of individual hospitals throughout the public hospital system, notwithstanding the fact that it is Government policy not to increase the overall number or percentage of private beds. This will facilitate maximum generation and collection of private-patient income.
Debt collection is now a standing item on the agenda for the HSE Audit Committee and the focus continues to be on the performance of individual hospitals in the management of their patient debt. Hospital managers have been informed that failure to improve on their debt-collection rates, where applicable, will result in budget sanctions that “equate with the level of non compliance”.