"With Convertigo, health care organizations increase reliability of reimbursements by automating patient data checks"

The Convertigo mashup platform has considerably reduced time spent checking data, and reimbursement is quicker.

Challenges

The modernization of the Health sector and the arrival of the “Carte Vitale” (Health Smart Card) have profoundly changed the management system for health care cost reimbursement. The allocation of resources to health care organizations is based on an activity payment rate (T2A). Since the beginning of 2009, there has been direct and individual invoicing for external consultations and hospital stays (PLFSS 2008).

To make this invoicing process more reliable and prevent errors and rejections, health care organizations can access Health Insurance databases to verify the rights of the insured party. This verification is required at two points:

• At time of admission of the patient to the establishment, during the input of dossier details
• At the time of invoicing, in case of rejection (B2) by the Health Insurance organization

Online consultation is essential in addition to the Health Smart Card, which may not always be up to date, or if the patient is not able to present the card upon entering the establishment. The online procedure is also used to check for patients who no longer have the Health Smart Card.

For all organizations whose procedures do not require a request for financial coverage (Medical Centers, Laboratories and Pharmacies, for instance), online consultation of supplementary health insurer data upon opening a dossier has become essential to prevent unpaid invoices. It is also important because the rights of insured individuals are changing with increasing frequency: a change in supplementary insurance due to competition, suspension of rights due to contribution incidents, etc.

The gathering of information is also required for improving the reliability of invoicing (for external treatment and stays) that are sent by the insurers, so as to minimize potential payment rejections and facilitate collection. These manual checks are fastidious and time-consuming. Certain health care insurers perform thousands of consultations per day, which means thousands of dossiers must also be checked to improve the reliability of the reimbursement system.

Objectives:

• To limit long and fastidious manual checks
• To ensure confidentiality of patient data
• To rapidly and easily access data with different sources and formats (supplementary health insurers)
• To automate the processes to limit input errors and processing rejections during reimbursement

Studies show that for 6% of amounts sent to Health Insurance, rejections are attributable to the poor quality of source data (more than a billion Electronic Claim Forms were certified in 2009).

Solution

In response to the needs of health care organizations, Convertigo has created the Convertigo Health Mashup, a unified access system for consulting data from the National Health Insurance organization and supplementary health insurers, accessible either via a portal or in the form of web services. The Convertigo Health Mashup is used by almost 150 health care organizations and, with a simple Web browser or in a Web service format, can be used to:

• Automate the consultation of the rights of insured individuals at the National Health Insurance organization (AMO)
• Find the supplementary health insurer of insured individuals and check their rights with a single search and a single form
• Simplify the connection to the sites of supplementary health insurers (130 to date) for coverage requests
• Interface with the invoicing module (patient administrative management module) to directly integrate the result of a search

The solution is offered in the form of a rental license in hosting mode, and does not require any technical investment.

Reasons for the Convertigo choice :

• A simple technological solution (no pre-requisites for the workstation, no server software installation)
• A non-intrusive technology that is used to dynamically extract strategic data from original third-party applications and diverse technologies
• The ability to automate checks and integrate the data in the establishment’s IT system in a simple way
• Fast implementation and controlled costs

Results

With the automation of checks, the quality of the invoicing system is greatly improved, so that rejections are reduced and National Health Insurance (AMO) and supplementary health insurer (AMC) payments are accelerated.

The ROI for the solution is rapid: for a service managing an inflow of 1,000 patients per day, savings are evaluated at more than 16 hours, the equivalent of two workdays of unproductive tasks.

With access to the data of supplementary health insurers, third-party coverage is facilitated, which increases patient satisfaction.

Last but not least, the integration of data in the IT system streamlines the process and prevents input errors.

Benefits :