Product Information
This product brings existing point of service (POS) financial service capabilities to the health care vertical. Specialized POS software exists for many verticals which are tailored to the specific needs of each industry. In the same way that big box retailers have their own software gateway to the card payment platform, the Medical Billing Gateway brings software to health care providers which enables them to capture a much greater portion of the patient payment responsibility.
The core product is software that captures and manages open authorizations on the card network system and holds that authorization until the health care provider knows the actual amount to be taken from the card account (post adjudication). It enables health care providers to perform one financial transaction – in the correct amount –for each patient encounter. This consumer friendly process allows the health care provider to collect the entire amount due from the patient without sending statements to the patient or utilizing an outsource billing or collection vendor.
Much like a hotel where the guest's payment card is authorized at check in and a financial settlement transaction is run at checkout, the The Medical Billing Gateway software enables a health care provider to obtain what amounts to a guarantee of the patient payment obligation when the patient is in the office and run the financial settlement at a later date when the third party payer has determined the amount the provider must collect from the patient.
The Company's core product uniquely marries a point of service calculator of patient liability to a payment card platform that enables delayed settlement transactions in a PCI certified environment. The product is designed to help the provider engage the consumer in the financial transaction at the point of service. The patient payment calculator is something that the health care provider can set up in minutes based on information it already has – its own charge master and health plan contracts. The product does not require connections to health plans or any third parties to be of benefit to the provider. The provider can configure it to replicate the current patient charge ticket. With just a few clicks on drop down menus, a clerk can show the patient what the expected patient payment liability will be. Like buying any other service, the patient can clearly see what he is paying for and can hand a card to the clerk for processing. A simple swipe of any credit or debit card on a USB connected wedge initiates the authorization.
The product has been certified by and accepts VISA, MasterCard, American Express and Discover. The patient payment acknowledgment is printed off and resembles any other retail card transaction that a patient makes.
It is simple for the patient – visit the doctor, get needed care, see what the services cost, swipe a payment card and be finished. There is no need for additional statements and bills from the provider months after the fact. It is simple and economical for the provider. The product can be used for all patients regardless of insurance carrier and for all payment cards, whether healthcare oriented or general purpose.
The Medical Billing Gateway charges the provider competitive card processing rates for co-pays and other completed transactions. An additional fee is charged to the provider for all delayed settlement transactions. The provider avoids the expense of sending bills to patient’s weeks or months after the fact The fee is less costly than, and can replace the historical costs of post-visit consumer collection methods.
Helping Health Care Providers Go Retail
This Gateway addresses the complex payment requirements unique to the health care environment. Consumer payment responsibility is increasing due to the growth of Consumer Driven Health Care (CDH) and deductible plans in general. This creates a pressing need to assist providers in the collection of patient payments at the point of service and to protect patients by assuring that they pay only insurance discounted amounts.
Currently, consumers pay over $250 billion annually directly to providers for their health care. In addition, health care providers are forced to write off an estimated $40 to $60 billion annually of amounts owed from patients. Both amounts are growing dramatically as medical costs continue to outpace inflation and plan sponsors shift more costs to consumers. Facilitating payments between patients and health care providers represents a significant opportunity and is anticipated to be a $3billion annual market by 2010.
The Medical Billing Gateway brings a unique health care vertical card transaction capability that allows providers to collect from the patient while the patient is still in the health care providers' office. This process greatly reduces bad debt exposure and eliminates the expense of sending multiple statements to the patient long after services have been provided. The push for consumer retail in health care, and the demand by health care providers to be paid like other service providers, creates the nexus and catalyst for process change in consumer payment of health care provider charges.
The Medical Billing Gateway delivers hosted software that supports a business process for physicians and health care providers to collect patient payment obligations at the point of service, in real time. The Medical Billing Gateway Provider Portal is a universal virtual POS terminal. Patients’ commitment to pay can be authorized at the point of service using the meraPay software against any card the patient prefers to use. When the claim has been fully adjudicated by the Health Plan, meraPay Gateway ensures that the correct and final patient payment is electronically sent to the Provider.
By using The Medical Billing Gateway application, a health care provider can increase its consumer collection rates from the industry standard of 50%,, to the 90+% that other retailers expect in their businesses. The business model is transaction fee based, and its value added service represents a significant premium to other processing solutions.
Technology
The Medical Billing Gateway is designed as a service. It has been architected to use simple, separate processes blended together in one useful application for a healthcare provider. The patient obligation calculator, authorization and delayed settlement sub processes are married into a single PCI certified environment and may be integrated into other non PCI certified systems in a simple straightforward manner.
The application’s architecture is developed using industry accepted development tools and systems. The business logic is developed in Java/J2EE/Hibernate. The web applications are built following an MVC paradigm using JSPs for display and Java Servlets for processing. To allow for streamlined partner integration, The Medical Billing Gateway provides ASP access to its core functionality via XML/HTTPS. This allows partners to integrate its functionality into their systems or for them to share data with the Gateway’s applications.
To protect cardholder data, card transactions are encrypted via SSL 2.0 using strong encryption, and sensitive data is stored using AES256 encryption. The Gateway’s data center, network/application architecture, and applications have been subject to and passed the PCI (Payment Card Industry) security audit. To ensure high availability, redundant networks are utilized throughout our data center. All load balancers, databases, and firewalls are in a primary/secondary failover configuration. All web and application servers are clustered. To ensure scalability, our applications have been designed in such a way that data can be distributed across multiple database servers. As the Company adds customers it will be able to optimize the size of each separate database to ensure stable performance rather than simply adding all customers to a single database and degrading performance incrementally as each new customer is added. The applications have also been designed to be clusterable.
Concluding Thoughts
The companion to great ideas is great timing. This Gateway has created a simple, easy to use product that allows health care providers to engage their patients in a retail payment transaction. The market is ready for this solution. Providers are searching for a way to interact better with their patients. Patients are increasingly being asked to pay for their routine encounters by health care providers. Three major industry trends are converging simultaneously with the launch of this patient revenue collection software. The shift of payment obligation from third party payers, to the patient, has been occurring under the guise of consumer driven health care (or simply as a result employer benefit cut backs). The demand for more provider price transparency and accountability brings the need for service cost estimating to the forefront. These movements are met with a growing nervousness on the part of physicians and hospitals who need a process for collecting their growing patient receivables. All three trends point to the need for a solution driven by the Gateway’s software which makes it simple for the patient and provider to conduct one financial transaction for the payment ofservices when they are rendered, like any other retail purchase.
