Eindar Khant, CEO, Passage Health International
The management of overseas patients has always posed a tremendous challenge to hospitals. Though such patients amount to only 5 percent of their overall activity, hospitals have a tough time dealing with international insurance policies. While the terms and conditions of various policies within one healthcare system are disparate enough already, the confusion is amplified when hospitals have to decipher healthcare provisions that are unique to each country.
To make matters worse, since a majority of travelers that end up in hospitals are rushed through the emergency room (ER) due to the nature of their injury/illness, hospitals have no option but to go ahead with critical procedures without adequate information about the patient—insurance eligibility, financial resources, and family details. “Most hospitals treat international patients and just pray that they’re going to be paid,” says Eindar Khant, CEO of Passage Health International (PHI). PHI is a healthcare revenue cycle management consultancy that specializes in managing the claims process for international patients on behalf of hospitals. And even when foreigners are adequately insured, it is no walk in the park for hospitals to submit claims due to the draconian policies and procedures enforced by various insurance companies.
Rather than being bogged down by these procedures, hospitals can utilize PHI’s full-service medical accounts receivable services through a simple phone call or email. Once activated, PHI simplifies the entire journey of processing claims for international patients—from verifying insurance benefits to the ultimate collection of payments from insurance companies (or even payments from patients). Regardless of the situation, PHI ensures that its “hospital partners” are paid accurately, and quickly, when treating foreigners. Khant elaborates, “It doesn’t matter where the patient is from, or where their insurance company is located, we have the capability and knowledge to process and manage claims.” To overcome language, time, and cultural barriers, PHI has set up a hub model for collections by stationing revenue management specialists across the world. For example, if a patient is admitted to a hospital in France, PHI’s representative in/around that location springs into action. “Even if the insurer in France rejects a claim, our representative resolves the issues and gets claims processed by using their knowledge of local governance,” adds Khant.
Regardless of the patient’s domicile, PHI follows a tried-and-tested process that guarantees hospitals peace of mind and expedited payments. As soon as a patient enters the ER, PHI’s verification department gathers information on the insurance benefits available to the patient and funnels that data back to the client within two hours. Once the hospital has the pertinent data, PHI provides them with what it calls, “market intelligence to make the right decisions.” The advisory element of PHI’s services is integral since hospitals need to be informed of the type of insurance for which the patient is eligible. Khant explains, “With our extensive knowledge of insurance companies and products, we know the requirements for filing a successful medical claim. For example, if an insurance company or product is flagged on our system, we inform the hospital that either the policy won’t pay (at all) or will offer a very low settlement.” Through such timely notifications, hospitals are equipped to make smarter business decisions. This delivery of “market intelligence” to hospitals is baked into PHI’s overall service model, which also includes the extent of care received by the patient.
It doesn’t matter where the patient is from, or where their insurance company is located, we have the capability and knowledge to process and manage claims
As an intermediary, they also provide care coordination for the patient. For example, if a patient needs to be moved to a different facility, so as to receive the appropriate level of care, PHI coordinates with the insurance company and the patient’s family to ensure a smooth transition (to a new hospital). PHI’s services don’t just end with patients receiving appropriate care. Once the patient is discharged, PHI collects all the medical records and itemized charges, ensuring that everything prescribed by the doctor (during a patient’s hospital stay) is captured on the bill and sent to the audit team for a comprehensive review. This bill review service is vital since “hospitals often leave money on the table,” according to Khant. “After the audit, our clients get a 5 to 20 percent increase in revenue they would have otherwise missed.”
As a result of the bill review, claims submitted by PHI to the insurance company have a high likelihood of instant claim approval, as illustrated by its historical denial rate of less than 1 percent. Typically, an average of 10 to 20 percent of claims filed with commercial health insurers have processing errors, which lead to paymentdelays or denials. However, PHI, owing to its rich history in the global insurance domain, has developed a process that eliminates coding or billing errors. Reduction of errors can make the difference between a hospital staying in the black or losing money, making PHI’s bill review and claim submission processes all the more essential. Khant narrates one such use case of a client that struggled to submit clean bills, “We found multiple coding errors in their claims submission. After we took over, they witnessed a 20 percent jump in their annual revenue.”
Additionally, PHI stores all records and other data on a highly customized cloud-based system, allowing for total transparency. “They can see the precise time and date we open a new case, timestamps of every piece of information and document-exchange, and all correspondence,” says Khant. PHI follows up on each claim on a biweekly basis, allowing its clients to measure and examine the entire service level matrix from patient’s ER admission to claims collection. The information can be retrieved at any time for audit purposes. Khant also informs that PHI follows a strict payment disbursement process, “We never hold onto funds for more than one week, and religiously disbursepayments to clients on Fridays.”
Moving forward, PHI intends to strengthen its reputation as “a one-stopshop” that focuses on more than just revenue cycle management and functioning as an extended business office for its hospitalpartners. Besides stationing representatives in different parts of the world, including the U.K., Peru, and India, PHI plans to add to its legal team— highly-reputed attorneys—that possess the know-how of global healthcare policies. In the coming years, PHI is focused on expanding its presence in the Southeast Asian market and other travel destinations such as Thailand, Dubai, and several parts of Europe. Meanwhile, the Mexican region remains a focus for PHI. With approximately 30 million Americans traveling to Mexico every year, PHI is targeting various tourist destinations between the Caribbean and Mexican regions. Khant notes, “We closely track everywhere Americans are traveling.”
In conclusion, PHI stands out from its peers due to its capability to manage the revenue cycle process from every side of the spectrum: the hospital, the insurance company, and the patient. Khant—who previously served as VP of AXA Assistance, Miami—cites his background in the insurance business as PHI’s key market differentiator. “I know the playbook on the other side of the fence. This knowledge helps us provide better service to our clients since I can relate to their mindset,” he concludes.