WASHINGTON (Reuters) – U.S. lawmakers returning next week to work on major healthcare legislation need to focus on insurance market reforms, consumer rebates and other measures that will curb soaring costs over time, economic and health experts said on Tuesday.

The group of academics outlined dozens of changes [...]]]> By Susan Heavey

WASHINGTON (Reuters) – U.S. lawmakers returning next week to work on major healthcare legislation need to focus on insurance market reforms, consumer rebates and other measures that will curb soaring costs over time, economic and health experts said on Tuesday.

The group of academics outlined dozens of changes in their report, from restructuring payments under the Medicare insurance program for the elderly and disabled to providing doctors incentive payments for helping avoid costly treatments or complications.

All of the proposals, some of which are already included in various congressional plans, together will help provide better care for patients while lowering costs over time, said Dr. Mark McClellan, a former economic official under President Bill Clinton and health official under President George W. Bush.

“We turned away from focusing just on short-term, isolated individual measures. While those small things like cutting Medicare prices across the board can have some short-term benefit, we don’t think steps like that are sufficient,” said McClellan, head of the Engelberg Center for Health Care Reform at the Brookings Institution, a Washington think tank that led the group.

Much of the national debate over efforts to reform the U.S. healthcare system and provide more Americans access to health insurance has centered around whether the government should provide its own alternative insurance plan and how much the overhaul will cost.

President Barack Obama, who made reform efforts a cornerstone of his campaign, has said he wants to pass a plan this year.

STRUCTURAL CHANGES

With congressional Democrats and Obama set to renew their pitch, the group said lawmakers need to ensure that final legislation includes various steps aimed at structural changes and payment incentives to reduce costs even decades from now.

While some of the group’s proposals are not new — such as promoting electronic health records and research that compares rival treatments — they join a chorus of other recent reports and comments that could help focus the debate.

“We believe that legislation needs to support a set of individual changes to help us get there,” McClellan told reporters in a conference call to discuss the report.

Among the recommendations are insurance industry changes that would make it easier to pool consumers who do not get health coverage from their employers, according to the group’s members, who hail from Harvard University and the University of California as well as other universities and think tanks.

Limits to employer tax breaks for insurance as well as a bidding process for private Medicare plans would also help foster insurance competition and lower costs, they said.

Robert Zirkelbach, spokesman for the industry group America’s Health Insurance Plans, declined to comment on the recommendations but said the group supports efforts aimed at containing costs and making insurance more affordable. The group represents Cigna Corp, UnitedHealth Group Inc and Aetna Inc, among others.

McClellan’s group also said payment changes are needed for doctors and other healthcare providers such as lump-sum, or “bundled,” payments for a treatment that would discourage costly mistakes rather than payments for each service.

Consumers, too, need added incentives to stay healthy such as rebates on their insurance premiums for meeting certain health goals or reducing their risk for disease by quitting smoking or other steps, it added.

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LAGUNA BEACH, Calif.–(BUSINESS WIRE)–The Healthcare Billing & Management Association (HBMA), a non-profit educational resource and advocacy group representing third-party medical billers and billing professionals, announced today that it presented member survey findings to executives [...]]]> Outreach Part of Broader Effort to Promote Administrative Simplification in Healthcare

LAGUNA BEACH, Calif.–(BUSINESS WIRE)–The Healthcare Billing & Management Association (HBMA), a non-profit educational resource and advocacy group representing third-party medical billers and billing professionals, announced today that it presented member survey findings to executives of America’s Health Insurance Plans (AHIP) at Institute 2009 in San Diego, Calif. in June. Presenting on behalf of HBMA member organizations, representatives discussed ways in which billing services and commercial payers can better work together to manage claims processing and related transactions more efficiently and effectively.

“HBMA is committed to its ongoing outreach efforts and is focused on securing cost reductions that will ultimately benefit all stakeholders, including payers, providers and patients,” says Brad Lund, HBMA executive director. “As part of HBMA’s efforts, we will also be reaching out to individual health insurance companies to identify practical administrative simplification solutions.”

In addition to identifying opportunities to drive down costs and produce administrative efficiencies, the following survey highlights were presented:

• 46 percent of member firms reported that fewer than 60 percent of insurance companies transmit denial information using HIPAA-standard codes
• 68 percent of member firms reported that 60 percent or more of all denials are ultimately paid by the insurance company after appeal or intervention
• 69 percent of member firms reported that cumbersome protocol for filing appeals is the most challenging aspect of handling claim denials

“Based on feedback from our members, HBMA has a solid understanding about what specific measures could impact administrative costs for the benefit of both providers and health plans,” says Sherri Dumford, an HBMA past president and the residing chair of HBMA’s Commercial Payer Relations Committee. “We appreciate the opportunity to share our findings, and we were pleased to find common ground in our efforts to enhance our nation’s healthcare system.”

Through the reciprocal exchange of ideas and coordinated efforts, HBMA collaborates with a broad range of leading industry associations including the American Medical Association, Blue Cross Blue Shield Association, CAQH, Cooperative Exchange, Emergency Department Practice Management Association, Medical Group Management Association, Radiology Business Management Association, Workgroup for Electronic Data Interchange and others.

About HBMA

A non-profit, member-led trade association, the Healthcare Billing & Management Association (HBMA) represents more than 30,000 employees at well over 650 third-party medical billing firms. Annually, HBMA companies submit more than 350 million initial claims on behalf of hospital-based physicians, office-based physicians and other allied healthcare providers. Founded in 1993, HBMA and its members foster personal development, advocate on the behalf of the profession, and promote cooperation through a wide range of business resources, educational events, networking opportunities, certification programs and adherence to the Medical Biller’s Code of Ethics. As the only trade association representing the interests of medical billers in Washington D.C., HBMA works with legislative stakeholders and federal agencies to improve the business of medical billing and the practice of healthcare. Learn more about how HBMA is elevating the medical billing profession at www.hbma.org.

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