Vipin - Neartail Business Profile

Growing Scrutiny of Prior Authorization and Billing Practices in Healthcare

The focus on prior authorization and billing practices in healthcare has intensified, especially after the tragic murder of UnitedHealthcare CEO, Brian Thompson. While this increased scrutiny may benefit patients, smaller healthcare providers, such as individual doctors and small hospitals, could face significant compliance fines ($2,000 per incident) and administrative costs. Even before this incident, New York State enacted a law aimed at improving patient protection and financial transparency in billing practices. This article explores how this law impacts healthcare providers' daily operations and its potential for broader adoption in the U.S. and globally.

New York’s Landmark Legislation

Last year, New York State introduced General Business Law Section 519-a and Public Health Law Section 18-c. Key provisions include:

Healthcare providers cannot demand credit card pre-authorization or retain card details before delivering emergency or medically necessary services.
Patients must be clearly informed about the risks of using credit cards for medical payments. Each time a patient opts for this method, they must acknowledge these risks.
Payment consent must be obtained separately from treatment consent, only after discussing treatment costs with the patient.

Section 18-c, which mandates separate consent for treatment and payment, was originally set to take effect on October 20, 2024, but its implementation has been delayed due to operational challenges. These laws highlight broader issues in payment systems, paving the way for further reforms. Similar initiatives have already been implemented in countries like Australia, where patient consent regulations prioritize transparency and fairness in medical billing.

Challenges faced by our customers

Amid these changes, I spoke with a healthcare provider about their challenges in adapting to the new rules. These discussions revealed some key difficulties:

1. Streamlining Payment Collection

Many providers use the "Card on File" (COF) method for convenience, allowing follow-up appointments and ongoing treatments to be charged without requiring patients to repeatedly enter card details. However, the new law requires:

Informing patients that medical bills paid by credit card are not treated as medical debt.
Explaining that by using a credit card, patients waive certain protections, such as limits on interest rates and restrictions on wage garnishment.
Obtaining patient acknowledgment of these risks for every payment.

These requirements make auto-pay impossible and necessitate manual consent for each charge, complicating payment workflows.

2. Managing Pre-Authorization Holds

While the law prohibits pre-authorization for emergency services, it allows this practice for non-emergency care. Pre-authorization temporarily holds funds but expires after seven days, complicating payments if scheduling issues arise. Extending the hold period or introducing a smoother reauthorization process could mitigate these challenges.

3. Automating Receipts and Superbills

Automating receipts and billing summaries (superbills) can improve efficiency, enhance communication, and build trust by ensuring timely updates to patients.

The Future of Healthcare Payments

New York’s legislative changes are part of broader efforts to increase transparency and protect patients from financial difficulties. However, they also emphasize the need for innovation to balance administrative efficiency with patient-focused care.

Potential Changes:

Consent Process: Instead of using an all-in-one consent form, providers could separate treatment and payment consent. For example, initial consent could allow saving card details for the first appointment, with additional consent obtained for future charges.
Patient Communication: Providers might adopt real-time notifications for upcoming charges and disclosures about payment risks. Automated receipts and superbills could further enhance transparency and reduce disputes.

Summary

Countries like Australia already have healthcare payment regulations similar to New York’s, emphasizing transparency and fairness in medical billing. This trend is likely to expand to other U.S. states and globally. At Formesign, we aim to ease the compliance and administrative burden for healthcare providers. However, we view patient consent not just as a regulatory requirement but as an ethical responsibility. Our goal is to simplify compliance through automation, such as sending emails or notifications to obtain patient consent. Our upcoming payment features will reflect this commitment. If you have feedback on pre-authorization or card-on-file processes, please leave a comment below or contact me directly.

Wed Jan 15 2025

New updates to enhance form security

Our current system already scans forms for malicious content and automatically displays a warning message in unsafe forms. However, due to a recent increase in reports of such forms through email and support channels, we are introducing a new Report Abuse option directly within the form.

This new feature will make it easier for users to flag any suspicious activity, helping us respond more quickly. Please note that this option will not appear when embedding the form on your website. Additionally, we're working on a future update that will introduce identification verification for added security when creating websites. This will allow us to remove the report abuse option for verified users and forms.

We’ll keep you informed about the upcoming security updates.

Sat Aug 31 2024

Issue with email notifications

Emails are not being sent due to an issue with the AWS account. We are looking into this. In the meantime, you can use the mobile app to get real time notifications for new responses.

Update: This issue has been resolved. You should receive email notifications now.

Thu May 23 2024

Forms Issue due to Google's ToS violation

Google had incorrectly flagged some of our forms for violating their terms of service. These forms might not have been accessible for 4 hrs on 27-April. We have now resolved this issue.

Note: If you are unable to access the form, please refresh the page or try it on a different browser/device.

Sat Apr 27 2024

Welcome to our new community experience!

We have created separate spaces for our products Formfacade, Neartail and Formesign so that our users can seek assistance, ask questions, share feedback, and also receive support from others who may have faced similar challenges. We will be using the announcements space to share product updates, showcase success stories and publish interview with our customers. If you have feedback or questions about the contents of the announcements, you can directly post a reply to the announcment. Engage in meaningful discussions. All announcements, posts and replies will be public. When you submit a post, only your name and the message will be visible to the public. Be respectful and avoid spam. You will have to login to reply to a post or announcements.

Fri Dec 01 2023

(This is a transcript of my talk for the AI hackathon at Kalvium. If you are hackathon participant, post your questions below.)

What to build?

Hello everyone, welcome to the AI hackathon! Before we dive into AI, let’s talk about what you should build for your hackathon. There are two kinds of applications you can work on: consumer applications and business applications. Since most of you haven’t worked in business, it makes sense to focus on consumer applications. The key is to solve a problem you face every day. This approach will make your projects relatable and impactful (Also read How to get startup ideas).

Let me share an example from my own experience. Several years ago, a CIO of a British company took me out to an Indian restaurant. They served these delicious pakoras, and he loved them so much that he ended up eating only pakoras for dinner. I sat there wondering whether I should say something about how unhealthy that was. Years later, I fell into the same trap. I only liked french fries and pastries when I moved to France. If we’re picky eaters and don’t know how food is made, we tend to pick the unhealthiest options. Ignorance is bliss, right? Or so I thought until my health suffered.

Finally, I found NutriScore—a scale that evaluates the nutrients in food. Instead of showing a number, it uses a simple, intuitive scale: "A" for very healthy, "B" for healthy, all the way down to "E" for unhealthy food—like a 5-star rating, but for health. However, NutriScore was only available in France and neighboring countries in Western Europe. I wanted it everywhere—whether I was in the US or India. And that’s how Neartail - food search was born—a search engine to find healthy food near you. When you search for "Protein salad," you see where it’s available near you and can check its NutriScore by clicking on it. So, think about your own daily struggles. Whether it’s finding healthy food options, staying organized, or improving productivity, solve a real problem you care about. That’s the best way to approach a hackathon project.

What to build?

Use Case 1: Search

Now, let’s get into how AI can help you solve problems, like we did with Neartail - food search.

The first AI use case we’ll cover is Search. There are two ways you can build a search engine:

Store all the web pages in a relational database. Then, when I enter "Protein salad" in the search box, you can use a "LIKE" query to search for that word in the database. That’s how old search engines like Yahoo used to work. In our case, "Chef Salad" wouldn’t show up in the search if we had used a "LIKE" query, even if it is packed with proteins.

To build a good search engine, you need to understand the meaning of the web page and the search term, then check if the meanings are similar. We use AI (embeddings) to find the meaning for pages like "Chef Salad" and the search term "Protein salad." Then, we find the closest web pages and list them. This is how modern search engines like Google and Neartail - food search work. This is why we see "Chef Salad" when we search for "Protein salad."

This method ensures that search results are not only relevant but also personalized based on context, like losing weight or building muscle mass.

Use Case 2: Classification

Ok, we’ve listed the food based on search. Now, we have to calculate NutriScore based on nutrients, right? Not so fast—NutriScore isn’t calculated the same way for all food. The fat in avocado is very different from the fat in beef. One is healthy, and the other isn’t. So, the NutriScore calculation changes based on the category of food—vegetable or meat. Before we can calculate a food’s NutriScore, we first need to classify it. Foods fall into categories like General foods, Red meat, Beverages, or Cheese.

Our classification model uses web page titles and content to identify the correct category. Let me show you an example of how we classify foods and calculate their health scores.

[Demo: Show Coke being classified under ‘beverages’ and how its NutriScore differs from ‘Chef Salad.’]

This classification ensures that the correct formula is applied—a crucial step before we even calculate the NutriScore. Once we have the category, we need to extract nutrient values to compute the score. That brings us to Extraction.

Use Case 3: Extraction

You’ve probably seen nutritional labels on food packages, right? Calories, sugar, fiber, fat—they’re all present on web pages too, but mostly as tables or paragraphs. To calculate NutriScore, we need these values in a structured format. That’s where AI steps in.

At Neartail - food search, we use AI to extract structured data from web pages. Let me show you how we input the title and content of a web page and extract information such as:

Ingredients (like sugar, salt, or flour);
Nutritional values per serving (like calories, fat, or protein);
Serving size (grams or milliliters).

[Demo: Show an example where a product’s serving size, ingredients, or nutrition data is extracted and generated if incomplete.]

Once we have this information, we can calculate NutriScore for each category using programming languages like Python or JavaScript.

Use Case 4: Generation

There is one problem though. Many restaurants don’t provide nutrition details for their dishes. These restaurants are often small, run by two or three people who don’t have time to maintain detailed websites. What do we do in such cases? This is where Generation comes in.

AI has access to vast amounts of data and knows how various dishes around the world are prepared and their typical nutrition values. We can use AI to generate missing nutrition data for dishes like ‘Chef Salad.’ While the output may not match the exact preparation method of a particular restaurant, it provides a reasonable estimate that can be displayed with a disclaimer: Nutritional values are estimated by AI.

[Demo: Show how the system generates guessed values for Coke and outputs complete data for an incomplete product.]

This capability ensures that even with incomplete inputs, users get meaningful, actionable insights. By bridging data gaps, we empower both consumers and businesses.

Conclusion

To wrap things up, AI is transforming the way we solve problems, from finding the healthiest foods to improving our daily lives. The four use cases we explored today—Search, Classification, Extraction, and Generation—are just the beginning. On top of these technologies, you can build agents that know your budget, find the healthiest food within it, and automatically place orders for you. Startups like ours and other big companies are building such agents as we speak. So, as you work on your hackathon projects, I encourage you to think about how you can use these AI techniques to tackle real problems—whether it’s improving health, education, or anything else that matters to you.

Once you have built a full stack solution that uses one or more of these usecases, there will be initial round of selection on where 20 teams based on these 4 criteria (25% for each) on Feb 1:

Idea - You can choose your own problem statement. How good it reflects their own pain point is the main criteria for this.
Solution - Which of the 4 usecases are you using and how well you have implemented them.
UX - How easy is it to use your solution for end users.
Presentation - How clearly are you presenting your project and how well you are answering our questions.

The final round will on Feb 8 & 9. take If you have further questions, post them below. Best of luck to all of you!

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