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Oligopsony (a market condition where buyers may not greatly affect the price and other market factors) provides insurance companies (buyers) strong bargaining position and prevents doctors (sellers) to combat abusive pay practices. To resolve this problem, all fifty states have established a law penalizing health insurers for late payments. Over the last decade, courts have imposed the condition of at least $ 76 million in fines against insurance companies for not complying with the laws of the payment system, according to AMA. The largest colonies of seven insurance companies and medical societies state totaled more than $ 1.53 million with only $ 384 million for direct payments to doctors (see Dave Hansen, "The promise has not induced to pay "AMNews, Nov. 5, 2007).

A oligopsony, according to Wikipedia, is a form of market in which the number of buyers is reduced, while that the number of vendors could be considerable. It's a mirror in front of an oligopoly, where there are many buyers but only a few suppliers:

1. The World Economy: Three companies (Cargill, Archer Daniels Midland, and Callebaut) buy the majority of world production of cocoa beans, mostly small farmers in the Third World.
2. The U.S. economy: producers of snuff against a cigarette manufacturer oligopsony, where three companies (Altria Brown & Williamson and Lorillard Tobacco Company) to purchase nearly 90% of snuff grown in the United States.
3. The American health insurance: A company insurance signed by at least 30% of the market on 299 of 313 metropolitan statistical areas. An insurer had 70% or more of the market in 74 areas, while in 15 sectors of the society at least 90% (AMA, 2007 Update "Competition in Health Insurance: A Comprehensive Study of U.S. Markets").

In each of these cases, buyers (taxpayers) have a great advantage over the sellers (suppliers). They can play one supplier against another, thereby reducing their costs. You can also dictate the exact specifications of the suppliers.

Today, forty-nine states require that claims are paid in 45 days or less. The proposal Dr. Wilson AMA health panel of the House Small Business Committee in August 2007, include several ideas to improve accountability, including:

• A strong federal standards. Demanding payment for 30 days to clean paper claims and 14 days for electronic clean claims.
• Higher fines than the state laws to discourage misconduct. The interest assessed on overdue payments and increasing interest to stage the crime of the claim. Including attorneys' fees when they win a claim dispute with an insurance company.
• Reporting deadlines. Federal law should establish a time limit established by law for insurers to inform doctors that the additional information needed to process a claim. The notice must indicate a problem with the application and give the opportunity to provide the necessary information. Les Insurers should be required to pay part of the application is complete and uncontested.

But it takes years to approve new laws. Worse, the proposed rules ignore modern technology and are lagging behind other sectors. For example, the proposed payment within 14 days of standard health insurance claims themselves are far behind the standard Wall Street to address huge volumes of transactions 24 hours and a level of telecommunications exchanges to complete bulk for multiple telephone calls between operators and customers within minutes of each conversation.

In addition to better information, a comprehensive measure and compare the performance of routine must be part of the process payment. Two doctors and chiropractic billing and management companies practice the athenahealth and billing accuracy, control and payment of work performance statistics, such as rate of pay and the percentage of accounts receivable over 120 days:

• Athenahealth (PayerView): the average number of days in accounts receivable
  1. Aetna 29.8
  2. 30.6 Human
  3. Cigna 31.9
  4. WellPoint 35.1
  5. Coventry Health Care 35.1
  6. UnitedHealth Group 38.3

• Precision Index Billing: Percentage of accounts receivable over 120 days – September 2007-14.3
  1. Medicare Illinois 5.9
  2. Blue Cross Blue Shield Illinois 7.3 (to 10 August)
  3. CIGNA 11.2 (to 16.4 in August)
  4. Aetna 11.7 (against 12.7 in August)
  5. New Medicare Jersey 12.5 (against 13.3 in August)
  6. United Healthcare 13.3 (vs. 11.3 in August)
  7. Blue Cross Blue Shield of Pennsylvania 14.8 (against 28.3 August)
  8. Blue Cross Blue Shield of New Jersey 14.9 (against 15.3 in August)
  9. GEICO 25
  10. Blue Cross Blue Shield of Georgia 31.2 (versus 22.9 in August)

In summary, the legal responsibility, measurement and global benchmarking is becoming a routine part of medical billing and payment process.

Yuval Lirov, PhD, author of “Practicing Profitability – Billing Network Effect for Revenue Cycle Control in Healthcare Clinics and Chiropractic Offices: Collections, Audit Risk, SOAP Notes, Scheduling, Care Plans, and Coding” (Affinity Billing) and “Mission Critical Systems Management” (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net – Distributed Medical Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com.

Barry Callebaut