CINICO patients have until 1 July to sign up for their mandatory CarePay cards so they can receive care at the Health Services Authority.
The authority, which runs the Cayman Islands Hospital and clinics, introduced CarePay, a billing and insurance adjudication system in May last year to help eliminate bad debts incurred through insurance denials and patients failing to pay.
The projected bad debt provision for the Health Services Authority, as of 30 June, 2013, is more than $12 million, while the unaudited bad debt provision for the end of the financial year last year was $11.4 million. The net accounts receivable as at 30 June, 2013, is projected to be $16.9 million.
The CarePay system is initially only for CINICO members, but Lizzette Yearwood, CEO of the Health Services Authority said discussions are under way to roll the plan out across private insurance companies as well.
“Come July 1, everyone accessing the service who is insured by CINICO must be registered,” she said. “We have been trying to encourage and remind people along the way, but we have to cut it off sometime – it’s been over a year now.”
“Let’s face it, you don’t go to Foster’s without your credit or debit card and think you’re going to walk out with a bag of groceries,” said Ms Yearwood.
The new system has not been without its hiccups, she admitted, saying glitches were still being sorted out.
“It was a huge project, something that has not been embarked upon in any other country, other than Jamaica, but there, they’re doing real-time adjudication. We’re taking it one step further because we integrated it with our medical records system, CERNER. That increased the complexity and we have to address other issues arising from that.
“It’s not working problem free at this point in time, we still have a few more tweaks to get done,” she said.
Those who show up at the hospital without their CarePay card in an emergency will still be treated, but any CINICO-insured individuals coming to the hospital without a CarePay card after 1 July will have to undergo a separate verification process and will be advised to get their CarePay card as soon as possible.
Ms Yearwood said bad debts from CINICO patients were not a major issue for the HSA, but the unrecoverable debts from privately insured, underinsured or completely uninsured patients were where the problems arose.
“We started it with CINICO. There is not a huge bad debt with CINICO, just a few denials here and there. When we will see the big difference is when we roll it out nationally, when the commercial insurance comes on board…
“Realistically speaking, we want to smooth out the kinks with CINICO first. Discussions have been held with an number of private insurance companies and the interest is gaining traction. We expect they will come on board, once we say it’s ready to go,” Ms Yearwood said.
When the system was launched last year, chairman of the Health Services Authority Canover Watson described it as a “revolutionary step” for the HSA that would help address the fact that a quarter of all overhead costs in healthcare were a result of billing system problems.
He anticipated that the CarePay and Real Time Adjudication system would result in cost savings of up to $40 million in the coming decade.
So far, 95 per cent of CINICO’s 13,000 members have received their CarePay cards, but there are still some holdouts.
The insurance company has been taking out advertisements in the local media in recent weeks, informing its members to register for their CarePay cards before 1 July.
Lonny Tibbetts, CEO of CINICO, said one of the key features of the CarePay system is the eligibility and verification of coverage of a member in real-time.
“Currently, when a member presents without a card, the administrative clerk at the [Health Services Authority] would ‘manually’ search the database and identify the member and process the invoice. Unfortunately, the system wasn’t designed for this manual ‘look-up’ feature, as such, this capacity circumvented a major security feature of the system.
“As the [HSA] is our PPO [preferred provider organisation], we permitted this temporary period of the manual look-up, however we now feel that sufficient time has passed to reinstate the mandatory ‘swipe’ feature, hence the renewed necessity of possession of the card.”
He added: “Moreover, the [HSA] will still have the manual capacity at limited locations for persons without their cards and or special cases.”
Without the system being in place, the HSA would have to contact CINICO for the same verification procedure for every encounter with a CINICO member. “As we only have a staff complement of 12, such a task would be completely insurmountable,” Mr. Tibbetts said.
How it works
The CarePay system works by each patient swiping his or her card at reception, upon which the hospital has immediate access to information about that patient’s insurance eligibility, how much of the cost of treatment the insurance company will cover and payment details, including if any bills are outstanding.
The HSA CEO said some of the outstanding debts at the hospital were from “self-pay” patients who don’t have any insurance.
“Those are the persons we have difficulty with,” she said. “More and more, we’re trying to enforce and encourage and educate the public on the importance of having insurance. Those persons that don’t have insurance don’t realise the necessity until they fall in need because of some catastrophic illness and it’s really, really sad when you have these people, especially if they’re not Caymanian, because there’s no option. We take care of them as best we can here and family and friends do fundraisers to send them overseas.
“I’m hoping that now we have the new SHIC benefit plan, more and more people will embrace that, it’s only in an emergency you understand how important it is.”
Any CINICO members without a CarePay card should contact CINICO or the government department for which they work to arrange to receive one.