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Related Experiment Videos

Automated claim and payment verification.

Mark J Segal1, Susan Morris, James M O Rubin

  • 1Medical Present Value, Inc., 100 NE Loop 410, San Antonio, TX 78216, USA.

The Journal of Medical Practice Management : MPM
|July 19, 2002
PubMed
Summary
This summary is machine-generated.

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Healthcare reimbursement lacks transparency, causing administrative costs and mistrust. An internet-based service, Phynance, verifies claims and payments, improving efficiency and lowering costs for all stakeholders.

Area of Science:

  • Health economics
  • Healthcare administration
  • Information technology in healthcare

Background:

  • Managed care has led to decreased transparency in healthcare reimbursement.
  • Lack of clarity in contracts and payment policies increases administrative costs, confusion, and mistrust among physicians, hospitals, payors, and patients.

Purpose of the Study:

  • To summarize problems associated with contract-based reimbursement in healthcare.
  • To present an innovative solution for improving transparency and accuracy in healthcare claims and payments.

Main Methods:

  • Description of an internet-based claims and payment verification service named Phynance.
  • Phynance automatically verifies the accuracy of claims and payments against contractual terms at a line-item level.
  • Analysis of implementation costs, processes, and return on investment for the service.

Related Experiment Videos

Main Results:

  • The Phynance service provides accurate information on contractual payment terms.
  • Enables medical practices to identify and apply correct reimbursement rates.
  • Demonstrates potential for improved business processes and cost reduction.

Conclusions:

  • Increased transparency in healthcare reimbursement is essential.
  • Phynance offers a technological solution to enhance accuracy, efficiency, and trust in the payment verification process.
  • The service benefits physicians, hospitals, payors, employers, and patients by lowering costs and improving operations.