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Streamlining administrative processes would require less time with paper and allow more time with patients



MaryKaye Brady, The Women's Clinic Administrator

The Women's Clinic, the oldest medical practice in Oregon specializing in the health and care of women, has nine obstetrician-gynecologists.

But given the rampant complexity of medical insurance these days, the clinic also employs four people whose job is to bill patients and the myriad health plans that cover them. A finance manager oversees the work of those four "billers." Another staff member's main responsibility is to verify the insurance benefits for surgeries and deliveries.

"Right now, we're doing more and more administrative work — for fewer and fewer patients," says MaryKaye Brady, the clinic's administrator.

If the medical staff didn't have to spend so much time weed-whacking through various forms and formats, it could spend more time on direct patient care and education, Brady says.

That's difficult as long as no two insurance forms are the same.

"We can easily deal with 1,000 different insurance formats in a year," says Brady, who has both a nursing degree and an MBA.

Brady participated in the Administrative Simplification work group, which made recommendations to the Oregon Health Policy Board. The group aimed to untangle that "red tape" by authorizing the state to require insurers to use the same language and formats in designing their "paperwork" — even if that paperwork is electronic.

Health plans differ not only in coverage, eligibility, benefits and authorization requirements. Sometimes the difference can be as trivial as the format for a simple date: whether the current year, for example, is expressed as "11" or "2011."

Such trivial-looking differences can be enough to trip a computer and slow down a claim.

A measure now before the legislature, Senate Bill 94, would grant authority to the Department of Consumer and Business Services (DCBS) to adopt one set of uniform standards for financial and administrative transactions between all health providers and insurers in the state.

The legislation would allow DCBS to require uniform administrative standards for all insurers and plan administrators, public and private, that pay for health care in Oregon.

Brady supports improving administrative processes, saying this would help streamline recordkeeping and bill paying. In turn, she says, that would not only eliminate the "hassle factor" for medical practices, but also reduce overhead costs and allow staff to spend more time with patients.