In 2000 ICSGlobal recognised how health industries globally were lagging behind other industries in the conversion from manual administration processes to electronic. ICSGlobal identified a business opportunity around applying the Internet to improve this, and launched a global "medical banking strategy".
There are two business streams to our medical banking strategy: the deployment of the Thelma healthcare transaction clearinghouse and the growth of our medical billing businesses - organically as well as via acquisition of other profitable medical billing businesses.
Our medical banking business is now active in three key markets, with customers reporting a range of benefits, including increased revenue, reliable cash flow and reduction in bad debt:
- Australia: Thelma went live in 2000 and volume has continued to grow at over 50% per annum since (see www.thelma.com.au)
- UK: In 2007 ICSGlobal acquired The London Patient Billing Service (LPBS), the UK's leading company in the outsourced patient billing services sector, which has since been renamed Medical Billing & Collection (MBC, see www.medbc.co.uk)
About medical banking and Thelma
"Medical banking" combines healthcare eCommerce (or "eHealth") and outsourced accounts receivable services to shift manual, paper-based healthcare administration processes into the realm of online banking.
The medical banking process begins the moment a patient contacts a doctor seeking help, and ends when that encounter or episode of care is complete, and all monies have been paid, received and accounted for. This process is also often referred to as the "revenue cycle".
Underpinning ICSGlobal's medical banking business is our configurable healthcare transaction clearinghouse, Thelma (Transaction Health Exchange Linking Multiple Applications), which clears and settles healthcare bills electronically over the Internet. This enables medical practices and hospitals to avoid the stress, time and cost of filling in forms and trying to work out who owes what to whom via phone, fax and post.
- What is the medical banking business model?
- What is meant by "outsourced accounts receivable services"?
- How does a medical billing company maximise a doctor's income?
- What types of transactions are involved in medical banking?
What is the medical banking business model?
There are two streams to our medical banking business, and each has a different revenue model.
The business model for the first stream, the Thelma clearinghouse, could be likened to the telephone, where users pay a nominal rental fee then a transaction fee each time they use the service, or they can choose to pay a fixed monthly fee for a bundled services package. As with local and long distance calls in the telephone model, there's a range of Thelma transaction fees depending on the volume and complexity of the transaction. The transaction fees are calculated to be just a fraction of what the manual processes cost. After eight years of operation, we have testimonials from Thelma customers that the Return on Investment (ROI) on Thelma transaction fees ranges from 300% to as high as 1000%.
The second stream is through our medical billing companies providing outsourced "accounts receivable" services to doctors. For these services we get paid a percentage of the revenue we collect. This arrangement generates a strong working relationship with each doctor, as we only get paid when they get paid.
Additional value can be generated in each business stream by connecting or "vertically integrating" them, enabling them to feed off each other.
What is meant by "outsourced accounts receivable services"?
The level of effort for private healthcare providers to file claims and get paid for their services varies from health system to health system. For example, the complexity of the UK healthcare system means it is virtually mandatory for doctors to seek assistance in getting paid. To do this they outsource their accounts receivable services to a medical billing company such as ICSGlobal's Medical Billing & Collection (MBC), who charges the doctors a percentage of the revenue they collect on their behalf. Our experience in the UK private healthcare system is that doctors report an increase in their earnings by up to 25% through outsourcing their accounts receivable services to ICSGlobal's Medical Billing & Collection (MBC) service.
In Australia, it is common for doctors seeing privately insured patients, or patients paying their own way, to collect their fees either before or at the point of consultation, thereby eliminating the need for the doctors to outsource their billing and collection, although some doctors still choose to do so.
How does a medical billing company maximise a doctor's income?
The whole focus of a medical billing company is to obtain reimbursement on behalf of doctors. This is a full-time job and if doctors want to maximise their time with patients, to be paid all that they are entitled to, to have steady cash flow and minimal bad debts, they need to let professionals perform their reimbursement tasks.
Healthcare systems are constantly changing: government policies and regulations, billing rules, medical codes, new technologies and insurance products. It is the job of the billing company to keep up with these changes, as they can affect a doctor's reimbursement or worse, cripple a practice if not complied with.
Another factor affecting the timeliness and amount of reimbursement to doctors is that, as pressure mounts on healthcare systems due to factors like rising costs and the ageing population, the insurance industry introduces stricter regulations and progressively puts up more barriers to making insurance claims. Billing companies have to stay fully informed of these changes as they occur.
So using a billing company not only means the doctor receives the maximum amount they are entitled to for the patients they have attended to, but also prevents the doctor from having to invest time in administration, and learning and keeping abreast of the science of getting paid, allowing them to maximise their time attending to patients, which generates further income.
ICSGlobal's medical banking customers commonly report increase in net revenue by 25%, and in some cases up to a staggering 100%; reliable cash flow; and reduction in bad debt to less than 0.5%.
What types of transactions are involved in medical banking?
How the full set of medical banking transactions are packaged up varies slightly from one health system to another, but fundamentally they aim to achieve the same outcome: to put healthcare providers and payers in control of their revenue cycle. The table below summarises the five basic medical banking workflow stages and the transactions associated with them.
| Transaction | Purpose |
| Eligibility Check | An Eligibility Check / Benefit Inquiry & Response allows healthcare providers to find out if a patient has health insurance, if so whether they need to collect a co-payment, etc. |
| Informed Financial Consent | IFC is an additional step to an Eligibility Check / Benefit Inquiry whereby all costs associated with the patient's procedure gets summarised onto an IFC form which the provider can print out and get the patient to sign to confirm that they are aware of all likely costs. |
| Claim | An electronic claim or bill for services rendered by a healthcare provider (doctor, hospital, dentist, lab, etc) to a healthcare payer (health insurer, Medicare, employer, etc) |
| Claim Status | A Claim Status Inquiry (Request) and Notification (Response) allows providers to track the status of their claims |
| Remittance Advice | A Claim Payment Remittance Advice, often called Explanation of Benefit (EOB), provides healthcare providers with an explanation of the payment they have received |