Insurance and Insurance Claims and Startup and Health Insurance and Health Care & Insurance

Q&A

April 28, 2010

Dr. Stanley Adkins is chief medical officer of Indianapolis-based AmeriVeriCR,  which launched early this year. It uses software to review medical claims for errors that slip through even after an insurance company or third-party administrator processes them. Essentially, AmeriVeri’s software makes sure that whatever health care service is provided to a patient (represented by a CPT code) matches properly with the patient’s diagnosis (represented by an ICD code).

AmeriVeri estimates that about 5 percent of claims have errors in them, which often end up costing employers more money. “It’s kind of like getting a hamburger at McDonald's and getting charged for two,” Adkins said. With health care reform and a new, larger set of diagnosis codes phasing in over the next three to four years, AmeriVeri thinks demand for its service will grow.

IBJ: How does your service end up saving money for employers?

A: If you get into a $100,000 heart bypass procedure, there’s a whole bunch of codes that go into that. A hospital will even bill for a Tylenol. There are so many codes that go into a system. The people doing the coding can make errors. It’s not a fault issue, by any means. It’s just the way the system is. The [employer] can send the file to us, and we’ll scrub it real-time. If there are errors, then those savings go directly to the [employer], and we get a percentage of that. If there are no errors, then there are no savings.

IBJ: What will the impact of the new set of diagnosis codes, ICD-10, be?

A: What will it do to the error rate [which is currently about 5 percent]? It will increase it. What will do to the business? I suspect it will increase it.

IBJ: What, if any, impact will the new health reform law have on your business?

A: I think it’s just going to get increasingly complicated and the people that are required to administer it are going to have to have more information. I think what’s going to happen in the next three or four years is there’s going to be an increasing need for this kind of scrub engine.

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