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German Statutory Health Insurance (national health insurance) has remained relatively intact over the past century, even in the face of governmental change and recent reforms. The overall story of German national health insurance is one of political compromise and successful implementation of communitarian values. Several key lessons from the German experience can be applied to the American health care system.
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Providers risk losing significant revenue when managed care contractual obligations go unmet. Contracts should identify claim payment expectations and limit administrative responsibilities tied to nonroutine services. Multidepartmental cooperation is needed to ensure compliance before, during, and after service delivery. Providers should employ technology to manage data related to copayment requirements, claims appeals, and patient eligibility.
Denials can be reduced by undertaking some simple steps: Transfer patients automatically from scheduling to pre-registration to have benefits verified and authorizations obtained. Make sure system data fields are large enough to enter all information needed. Track the frequency of denials for noncontracted services and either include them in the contract at renegotiation or discontinue the billing.
Like those who are eligible for full Medicare and full Medicaid, people eligible for the Medicare Savings Programs are also referred to as dual eligibles or dual enrollees. And like their counterparts, they face special access and eligibility issues. In this second brief in our series on dual enrollees, we discuss issues that your clients may face as they seek to enroll in and use Medicare Savings Programs.
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