Every health broker has clients who are getting medical bills that contain errors.
Jim Napoli can say that because it's his business to find those errors. Napoli is the CEO of Medliminal, which uses "robotic process automation" technology to spot discrepancies in medical billing.
The company is expected to save clients more than $200 million this year, he said. A prominent ERISA attorney for more than 20 years, Napoli said the technology is rapidly making medical payment integrity an ERISA fiduciary responsibility.
"There are a lot of changes in the billing, especially with COVID-19, so it’s difficult sometimes for the hospital to keep up, so we catch those mistakes," he said.
Napoli planned to speak on this topic during a Monday session at the National Association of Health Underwriters' virtual conference. His presentation is titled "Medical Bill Cost Containment – a Fiduciary Duty Under ERISA."
While some might say the broker's job is done once the coverage transaction is complete, Napoli said it doesn't have to be. In fact, taking an interest in medical bills can help a health broker to stand out from the crowd.
"A lot of brokers are now what I would consider consultants as much as they are brokers," Napoli explained. "And to have that level of knowledge and to understand the ERISA implications of not having a medical payment integrity program in place is quite a differentiator. That brokers deserves to be paid additional."
An audit by credit rating agency Equifax found that for hospital bills totaling $10,000 or more, there was an average error of $1,300. According to several studies, errors are most commonly found for inpatient care, complex procedure involving different specialists and treatment by providers outside a patient's network.
"There are a lot of charges that are essential to the service that is being provided. Think of that as the baseline," Napoli explained. "If something is essential to the surgery you can’t change that separately."
One common over-billing error is the hospital charging for treatment of a medical problem caused by the original treatment, Napoli said. For example, the surgeon who leaves a sponge inside a patient during an operation. Charges for a procedure to remove the sponge would be a mistake Medliminal would challenge, Napoli said.
The problems with medical billing are not improving, he added.
“It’s getting a little worse for two reasons," Napoli said. "One is because there are so many changes to the rules. In addition, due to the pandemic, or anytime there’s any sort of recession that hits the hospitals, there’s going to be a premium on trying to build as much as possible. So there are times where the hospitals may try to push the limits."
InsuranceNewsNet Senior Editor John Hilton has covered business and other beats in more than 20 years of daily journalism. John may be reached at [email protected] Follow him on Twitter @INNJohnH.
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