My automobile has a 17-digit VIN (vehicle identification number). However, to some in managed care, even this is inadequate for patients. One payor has a nearly-unbelievable 26-digit patient identifier required for billing purposes. If this does not violate every precept of common sense human/machine interaction in busy clinical settings, I'm not sure what would.
As reported in "Magellan Health's procedures attacked", Philadelphia Inquirer, Wed, Apr. 20, 2005, The Pennsylvania Psychological Association blasted Magellan Health Services for what it called inefficient rules and bureaucratic roadblocks that it said keep Southeastern Pennsylvania patients from getting psychological care and therapists from getting paid.
Therapists have been dropped temporarily from Magellan's rolls for no apparent reason, and communication with the company is so slow it's sometimes impossible to meet deadlines, the association said in a report released to the public. Magellan assigns each patient a 26-digit code, which is difficult to type properly and has caused many bills to be rejected, psychologists said. Magellan manages mental-health services for the region's two dominant private insurers, Independence Blue Cross and Aetna Inc.
(Note: for the mathematically-minded, a 26-digit number could be used to uniquely identify over 99 septillion individuals - that's 99,999,999,999,999,999,999,999,999 - and many, many more if alphanumerics are allowed!)
The article goes on to state:
The company defended its practices. "We're very proud of our track record in Pennsylvania and around the country," spokeswoman Erin Somers said. The company has tried to enhance "services and operations" in the last two years, and "the feedback that we've gotten from our stakeholders... has been very positive in a majority of cases."Sam Knapp, director of professional affairs for the psychological association, said it was the first time his group had taken this kind of action. "The only reason we did it is because the quality of administrative services just became horrible in the last six months," he said. "It was never that great." The company's procedures, he said, "waste money and they disrupt patient treatment."
Magellan controls mental-health treatment for virtually all of the private HMO market in the region, and also manages care for many employer-operated plans and for Medicaid patients in Bucks, Delaware and Montgomery Counties.
... Rep. Dennis O'Brien (R., Phila.), chairman of the state House Judiciary Committee, said yesterday that he hoped to hold hearings next month on issues raised in the report. "I have some real concerns with Magellan," he said. "I think there's enough questions here that we'll bring people in and we'll let them tell the story."
... The psychological association report focused on problems in four areas: authorization to provide care, which is required before bills will be paid; credentialing or approval of therapists for an insurance company's network, also a billing requirement; billing itself; and appeals of denied care.
The report was based on a random survey responded to by 73 Philadelphia-area psychologists in Magellan networks, plus discussions with psychologists who work with the company ... The psychologists told the association that 30 percent to 35 percent of their budgets go to satisfying insurance company demands.
Tom Whiteman, a psychologist who directs Life Counseling Services, a practice with 100 therapists in Pennsylvania and New Jersey, said Magellan controlled 90 percent of his business. He has one full-time worker who does nothing but pursue denied claims.
Something as benign as a therapist's marriage can upset billing for months, he said in an interview. He tells employees never to change their names. "It can take them six months to change you in the computer," he said. "In the meantime, every claim will be denied."
... Vince Bellwoar, a psychologist who runs a large group practice based in Delaware County, said it took Magellan six weeks to kick back one report because a therapist had forgotten to write in the patient's birth date. When that was corrected, it took the company three days to reject the claim because it was late. Eventually, Bellwoar's group got some of its money.
This kind of thing wears on therapists, Bellwoar said. "These aren't huge obstacles. These are hurdles, but after a while you just want to stop jumping over the hurdles, and the patients want to stop jumping over the hurdles."
Such widely-divergent reports leave me skeptical. Considering the implications of implementing a 26-digit identifier as a starting point of the claims and reimbursement processes, I'd tend to find the quoted practitioners' complaints more credible.
In any case, ill-conceived and implemented information technology that requires an easily-corrupted 26-digit patient identifier and six months to change a name of a provider employee for billing purposes, and processes that require practice owners to have full-time employees to work on denials and expend a third of their budgets for insurance paperwork and other administrivia, simply have no place in modern healthcare. This seems a prime example of bureaucrats living parastically off of clinicians, sucking their lifeblood.
-- SS
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