Perfect Disease Management Medical Billing Myth

Perfect Disease Management Medical Billing Myth

Medical billing for disease management is not working for many insurance companies. Disease management has been a trend in the recent years. However, model programs are being shut down all over the country. Lack of interest is the downfall of these disease management programs. Medical billing and revenue for the year will fail due to disease management closings.

A model disease management program, HeartPartners will be closing ten months early. The payer, PacifiCare Health Systems, cannot take any more medical billing loss. They were severely short on beneficiaries. They anticipated 15,000 beneficiaries, however only 3750 people actually enrolled in the program.

Disease management is intended to educate patients about their disease. Information is given about possible treatments, medications, advancements, etc. As a matter of fact, disease management is intended to save money in the medical billing field. Sadly, HeartPartners did nothing but hurt medical billing for Pacificare Health Systems.

Perhaps it was a lack of knowledge of the program. Many possible enrollees and disease management programs are senior citizens. Many of these people don’t have access to the World Wide Web. Unfortunately, this is the avenue many insurance companies use to spread the word. In order for medical billing to improve with disease management, awareness needs to take place.

Unfortunately, the closure of the HeartPartners disease management program led to a $3.5 million loss of revenue. Disease management programs are a step in the right direction for medical billing. Hopefully, this will be a learning experience for payers and disease management programs alike. Improvements should always be made to medical billing . Even if disease management is not the solution to the problem, it is the first step. Perhaps it will lead to the design of the new medical billing improvements system in the future.

View all Articles by: Melissa Clark, CCS-P