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ClaimsMobile: Mobile medical claims management for output-based healthcare
Challenges:
In this project, contracted clinics treat patients in exchange for vouchers, which are returned to the disbursement agency, along with a paper claim, for reimbursement. This "output-based" form of aid is intended to address skewed incentives by reimbursing clinics for services provided rather than services expected (see ICAS background paper). However, this approach is information intensive, and while the incentive structure is improved, the administrative overhead is increased. Furthermore, limitations in physical and communication infrastructure result in healthcare providers and management staff feeling discouraged by lack of feedback from the head office. Poorly filed paper claims result in disbursement delays and lost income. In addition, rural clinics face unreliable power and minimal security. In this context mobile phones offer a viable computing and communications platform for data management.
Clinics reside in a vast information ecosystem, interacting with Ministry of Health (reporting outpatient statistics via regular HMIS reports), Joint Medical Stores (resupplying pharmaceuticals), a variety of aid agencies, health insurance companies, patients, and others. By introducing a smartphone and web-application system for submitting and reviewing claims, we hope to reduce the delays and errors, increase clinics' profitability and improve communication. ClaimsMobile has two main components, a mobile phone for use in the clinics to manage and submit electronic claims, and a web application, which receives the claims from the clinics and serves as the main user interface for the management staff. In addition to improving health information management in clinics and communication between the clinics and the management agency, the use of ClaimsMobile will also enable the project to scale over larger geographical areas by providing a reliable data distribution and collection mechanism for both financial and health information.
Since claims printed on
Since claims printed on paper and mailed often take longer to get paid, the percentage of EDI claims versus paper claims should be tracked.web host The most interesting part is ClaimsMobile has two main components, a mobile phone for use in the clinics to manage and submit electronic claims, and a web application, which receives the claims from the clinics and serves as the main user interface for the management staff. In addition to improving health information management in clinics and communication between the clinics and the management agency, the use of ClaimsMobile will also enable the project to scale over larger geographical areas by providing a reliable data distribution and collection mechanism for both financial and health information.
ClaimsMobile
You say that the paper forms are often poorly filed and cause delays - but is there evidence that electronic forms will be more accurately completed? also the paper forms leave a "trail" that is useful for fraud control using thumbprints, bar codes, handwriting, neatness etc - will the paper forms vanish or will both be filled?
Many providers outsource
Many providers outsource claims submission to vendors that transmit electronic claims to electronic data interchange (EDI)-capable payers and that mail claims to paper-based payers. This solution avoids the problems inherent in managing dual paper and electronic work flows. Several hundred claims submission vendors offer this service to hospitals, medical groups, and other providers.
Paper versus electronic claims
This is a very good question and thank you for starting the discussion! I think it is reasonable to assume that data forms on a phone or laptop can be more accurately completed with drop-down menus, check boxes, character limits and other data entry constraints that avoid the error of non-standard terms that we see on the paper forms. You raise a good point about the paper trail. The physical voucher remains a very important part of the claims process. The electronic claims process will have to incorporate evidence of physical vouchers through use of unique numbers, photographic images (camera phones) or other anti-fraud techniques. Paper remains a useful power-free way to archive information. The mobile application will likely complement the use of paper forms for some time yet as providers and program managers take ownership of the technology.