Proper billing is the bane of many hospitals and healthcare organizations.
And no matter how hard some organizations try to collect overdue or even regular bills, they may not receive their due. This is where the National Healthcare Payer Network comes in. Based in Wayne, Pennsylvania the company takes a retrospective process to balance billing and auditing and changes the paradigm to a prospective solution, according to the principals of NHPN, Kurt Kozin and Ian Michel.
The company, which began two years ago, specializes in acute care hospitals and has twelve contracting groups that represent 21 hospitals. Kozin brings 20 years of experience from the insurance industry while Michel offers experience from several healthcare organizations.
Ian Michel (left) and Kurt Kozin
“We saw an opportunity to turn the tables on health insurance companies,” Michel said. “We help hospitals work with managed care companies and do everything from the review and auditing of claims. We are changing the relationship between the payers, managed care organizations and our client health systems.”
Kozin said that he has observed that many hospitals are simply giving away money in pricing discounts. Many hospitals receive most of their money from three to four significant payers; usually Medicare is one of the major ones and dont pursue the smaller, less significant payers. These smaller payers still comprise a significant source of revenue and change the financial outlook of hospitals and other providers, including moving from red to black.
“Historically, providers contracted with managed care organizations to direct patients to generate revenue to the health systems,” Kozin said. “However most hospitals sign managed care contracts but neglect to track volume. Unfortunately, one bad contract and lead to hundreds of payers obtaining discounts on claims and significantly reduce revenues. To compound this unfortunate situation, most providers just do not have the staff to monitor compliance to see how they are harmed by deceptive and abusive contracting methods.”
Steve Wylie, VP Financial Operation at Essent Healthcare said, “Providers today need to adapt too many forces that drive change management and NHPN is an organization that specializes in managed care and reimbursement imperatives with providers knowing that reenginerring creates significant opportunities for providers. For that reason, we are pleased to expand our relationships with NHPN to include aligning with NHPN on managed care initiatives. Their innovation solution sets and expertise in the healthcare industry has been indispensable and the ideal choice for our corporate culture,” he said.
“There is a lack of compliance monitoring on contracts,” Kozin said. “Providers are not being paid appropriately and in fact patients may pay a higher percentage of the bill. The insurance companies benefit by taking a discount and minimizing their liability.”
To correct these abuses, Kozin said, “NHPN takes full responsibility for all or a subset of contracts and claims.”
“We hold payers responsible for payments,” he said. “I see us expanding exponentially to encompassing all types of providers, as an out-partnering resource to help all providers increase profits and work flow efficiencies.”
