Innovative systems are allowing hospitals to quickly process private health insurance claims, writes Leslie Faughnan, Sunday Business Post, 16/10/11.



The healthcare and insurance sector share at least one attribute, detailed and complex administration. That was the start point for Irish software company Sláinte Healthcare in 2006. It has developed innovative systems to enable healthcare providers to handle the processing of claims through private insurance companies more efficiently and therefore faster. “In hospitals as in the private sector, cash flow is more important than ever. We have enabled our clients to reduce collection times for claims payments from perhaps as slow as 180 debtor days down to 45 or even less” said Andrew Murphy, chief executive of Sláinte Healthcare.



The original Sláinte product and still the core is Claimsure, a comprehensive health insurance revenue cycle management solution, supporting all aspects of the claim cycle. As anyone who has ever made a claim understands, it has to be complete and fully documented before the insurance company can process it. Somewhere in that administrative thicket is the explanation for some of the recent adverse publicity and political statements about public hospitals and uncollected money from private patients. Without smart systems it can be a very difficult and time consuming set of tasks, which is the basic business case for Claimsure software. “The requirement is for full collation, all or nothing” Murphy said. “We have also enabled our clients to move onto direct electronic submission of claims, which ensures automatic logging of all interaction with the insurer and the entire claim process.”



Today, Claimsure is being used to manage an estimated annual total of more than €100million in private insurance claims from both public and private hospitals in Ireland. Supported by Enterprise Ireland as a high potential start up, Sláinte has gone on to identify almost identical healthcare administration challenges in other markets. It is now active in Britain, the US, Australia and the Middle East and currently employs over 50 staff. The Claimsure system tracks everything related to the insured patient from signature on admission to discharge, with all of the procedures, medications and other extras accumulated along the hospital journey. The result is a major reduction in the staff time involved in preparing a claim and the period from patient discharge to claim. It also reduces the rate of pending claims and has a major impact on rejection of claims.



“We also integrate seamlessly with other existing systems in hospitals, automatically tracking and extracting the information needed for a patient insurance claim” said Murphy. In fact, the company has developed such expertise in healthcare systems integration that it also now offers specialist software products and service in this sphere. Sláinte has also extended its systems beyond insurance claims processing into general hospital administration and clinical patient records. “It is very important for hospital managers to optimise their bed utilisation. From an income point of view, for example, a public patient in a private bed means an empty bed in revenue terms,” Murphy said. “Our systems are helping to give managers clear visibility of their usage patterns, across many areas in addition to bed utilisation.”



Some of the state’s major hospitals are using Sláinte Healthcare’s systems, including the Mater, St. James and Crumlin Children’s hospitals in Dublin. Brian Conlon, chief executive of the Mater Hospital, is unequivocal about the value of the software: “We are very happy that we invested in Claimsure and are reaping the benefits of the implementation with debtor days reducing and much stronger private income receipts.” “Almost as important is the impact the project has made on how the hospital works internally, not just with the health insurance process but in how admissions are now handled and even how we present clinical summaries to consultants for electronic sign off” Conlon said.



Across the city at Our Lady’s Hospital in Crumlin, management is seeing results after just a few months with the Claimsure system in place. “We decided to invest in Claimsure to maximise our chances of improving our health insurance income to offset the budgetary constraints we are under,” said David Slevin, director of finance. “We are already seeing the benefits as our claims submissions have doubled on average since the system went live. The engagement by the medical consultants in the electronic process has been extremely positive,” said Slevin. “As a result we are beginning to effect control of our private income debtor balances. We have also been able to utilise the system to support initiatives in maximising the bed income which is yielding major increases in accrued income for the hospital” he said. “From a financial point of view, the system has already justified the cost of implementation.”