Clearwave

For the first time a vendor is bringing a solution to market that benefits both the government and private sectors. By using the Clearwave kiosk, all patients, whether Medicaid, Medicare, Aetna, United or others, can check-in using the same device and the same process.

Situation

While fraud and abuse in many state-wide Medicaid programs can not accurately be measured, many states do complain about the costly abuse from both patients who share their cards with other, ineligible patients and from physicians who take advantage of the system with actions such as double billing or charging for services not rendered. In fact, New York alone estimates 10 to 40 percent of spending on its Medicaid program goes to fraud and abuse annually. This example addresses the state and nation-wide predicament of fraud, waste and abuse among Medicaid populations due to the lack of patient authentication and eligibility verification at the point of service.

The example below is also applicable to non-government programs such as commercial insurance companies and private physician groups. Today, physician practices are victims of administrative inefficiencies that consume dollars erroneously. Ensuring a patient's eligibility status and deductible information should be accomplished seamlessly and electronically, not through a 20 minute, 1-800 number phone call or multiple websites.

Solution

For the first time a vendor is bringing a solution to market that benefits both the government and private sectors. By using the Clearwave kiosk, all patients, whether Medicaid, Medicare, Aetna, United or others, can check-in using the same device and the same process. In addition to reducing costs and improving administrative efficiencies, Clearwave also offers an added benefit with a Radio Frequency Identification (RFID) card. The RFID card can also be used by both government and private sectors and will replace the card that is currently issued. It enables patients to check themselves in and out of the physician?s office using a fully functional, self service kiosk device. Upon arrival at the physician?s office, the patient will wave the RFID card at the kiosk, enter a unique PIN number to unlock a secure server database and verify that the demographic and personal health information displayed on the screen is correct. The information, including a digital photograph on the card (if obtainable), will significantly decrease patient fraud and it will automatically be uploaded to the physician?s computer system. Once the patient is checked-in, an Electronic Data Interchange (EDI) system will complete HIPAA-compliant 270 and 271 eligibility verification transactions which will ensure that the patient is eligible to receive physician services. The card and kiosk combined answer two of the main problems with patient fraud: they authenticate the patient and they verify that patient is eligible for the benefits.

The objective is to reduce expenses by attacking overall cost drivers. One cost driver ? administrative inefficiencies ? can be proactively addressed and will lead to a reduction in overall costs. By establishing an electronic link to each patient?s visit using an RFID card, intelligent kiosks and electronic portals, for example Medicaid can:

• Reduce physician and patient fraud, waste and abuse costs
• Ensure patients receiving services on behalf of Medicaid are eligible
• Reduce card re-issuance
• Enable portable personal health records increasing the quality of care and overall health management.

Clearwave's kiosk was designed to drive 100% of patients to it. Those patients without an RFID card can still check-in at the kiosk by entering basic information found on insurance cards. Physician practices save time and money when Clearwave?s kiosk is used for patient registration including, check-in, electronic eligibility verification, individual health records and payment processing.

Better Health & Lower Cost

Verifying eligibility status can take an office administrator anywhere from 5-45 minutes. We connect to over 1000 insurance companies to ensure automated responses within 10 seconds. Information, including eligibility status, co-pay and deductible, is sent electronically - directly to your desktop. The overall check-in time for each patient decreases significantly so you spend less time on paperwork and more time on patients.

Additional analysis is currently being examined and will be available some time in 2006. Clearwave is assessing the impact its solution has on:

• Cost savings for physicians and employers
• Increased revenue for physicians
• Access to real time information
• Communication between employers, patients, payors and physicians
• Patient quality of care
• Decreased fraud, waste and abuse
• Ability to share personal individual health records
  

Some doctors' offices in Tampa, FL have installed Clearwave's Kiosk.