Axiom Health Group Brings New Payer Assurance Reimbursement Model to ACO and CO-OP Clients

May 18, 2012 - PRLog -- Developing new forms of revenue and managing risk are critical objectives for insurance payers faced with medical loss ratio mandates. Industry pundits of the new payment assurance model of reimbursement suggest that the next trend in healthcare reimbursement for providers is to integrate claims adjudication with employee payroll deductions so that out-of-pocket costs are automatically paid to providers in a single transaction. Not only would the fund transfer benefit the providers and payers with reduced costs of collection that could be negotiated into lowered fees, but it would also create a paper trail of costs that the employee would be able to track and consider.

Payment assurance is a set of reimbursement processes and methods that aligns payer and provider reimbursement objectives through integration of patient financial responsibility payment into a unified reimbursement workflow. With the increasing trend towards high-deductible health plans, front-end patient financial responsibility continues to rise for providers. This trend brings with it increased patient collections activity, and write-offs for uncollectible patient accounts are also increasing. Payment assurance reimbursement is now available to clients of Axiom Health Group, located in Denver, Colorado.

Axiom Health Group (http://axiomhealthgroup.com) is one of a very small number of ACO development consultants in the nation that is able to connect payers and providers using this state of the art provider payment settlement technology through a unified platform for all plan types and payment types. The technology is supported by integrated toolsets for managing transaction flow, predictive modeling and health analytics, automated payment and reconciliation of claims, banking and security for ACOs, IPAs, PHOs, MSOs, and CO-OPs.

Payment assurance reimbursement:
•   reduces administrative costs for both payers and providers
•   creates non-premium revenue
•   strengthens provider contracting, and
•   improves the customer experience at the point of care (important for HCAHPS scoring and patient satisfaction)

7 new models of payment assurance model reimbursement

Currently available from Axiom Health Group channel partners are at least 7 new models of payer assurance model reimbursement, including:

Facilitator model: Where the payer assumes no financial risk for patient financial responsibility, but provides enabling capabilities and technologies to assist the provider with collections.

Limited Exposure Model: Where the payer designs the program to share the member collections risk with the employer, which may include minimum funding of an HRA (as an example) or programs such as the MyHealthSavingsUSA™ transparency/rewards program.

Co-Pay Excluded Model: Payer assures co-insurance and deductible amounts, but not he copayment amounts. Provider still collects point of service co-payments.

Network Access Model: Payer sells an add-on to the employer that is fee-based to incorporate the assurance payment feature as a part of the medical benefits package. The employer may gain access to “preferred pricing” from a narrow network of high-performance, high-quality participating providers by paying an access fee to add the payment assurance convenience feature for their employees.

Limit by Plan Design: Payer only offers the payment assurance model on plan designs that are limited at a certain threshold of patient responsibility.

Participation and Contracting: Payment assurance is only available to participating providers and the providers must agree to accept a virtual card payment.

Payment Plan: Plan members can elect a loan instrument to finance their payment to the payer that is either funded by the payer or an affiliated financial institution. Providers will also be able to offer financing and cash flow options from Payer-branded products (similar to consumer health loan programs already on the market from independent vendors and banks).

Assurance-models of reimbursement also provide a strong framework for bundled payments and accountable care reimbursement. By placing the payer at the epicenter of the revenue cycle and not just the risk and expenses, both payers and providers will have greater insight into reimbursement costs, product design, improved alignment with contracted providers through integrated business processes, and diversified revenue generation through non-premium-based business services and banking fees.

Payer-to-provider payment programs and payment assurance models in which the payer intermediates the consumer-to-provider payment in a cashless system will be used to help payers secure more favorable contracts and network agreements and create stronger competitive boundaries within health insurance exchanges.

By realizing the total spent on healthcare, members might be inspired to make cost-effective decisions, choose more suitable plan products and take more responsibility for their health. This cultural change, coupled with pricing transparency programs now available from the new MyHealthSavingsUSA™ (http://MyHealthSavingsUSA.com) program by MHI Benefits Group (http://mhibenefitsgroup.com) in Colorado enable plan members to call a toll-free private concierge line that provides actual negotiated plan member rates. The MyHealthSavingsUSA™ program is 100% voluntary, confidential, and available free to employees of participating employer-sponsored group health plans.

In that program, callers are provided pricing information and offered concierge services such as courtesy appointment booking and electronic medical records transfer from their ordering physician to the diagnostic provider if they choose to utilize a lower cost provider. A nurse advice line is also available to answer questions about their test or procedure. As a bonus, their insurer or self-funded employer or union benefit plan pays them a cash payment of up to up to $75 to reward them for choosing a lower cost provider.

The only way individuals will become more engaged with the cost of healthcare is to make sure they are able to shop more prudently, identify savings opportunities among network providers and meet their payment responsibilities. Too many patients who receive care and walk away from the bill with no intention of paying their out-of-pocket costs.

About Axiom Health Group
Axiom is a new, branded solution for Mercury Healthcare International’s consultancy specializing in Integrated Health Delivery System development under US healthcare reform. Axiom consultants lead the way for new integrated health delivery systems, ACOs and CO-OPs. Trusted for organizational development of integrated healthcare provider organizations, infrastructure design, and implementation since 1991, healthcare providers in every state and several U.S. territories have looked to Axiom consultants for innovation and solutions to help them provide value-based accountable care through provider integration and alignment.

For more information on payment assurance reimbursement, Axiom Health Group, MHI Benefits Group or the MyHealthSavingsUSA™ program, please contact:

The Mercury Healthcare Companies
800.727.4160