By Emily Bonham, senior vice president of product management, AGS Health.
In healthcare revenue cycle management (RCM), we’ve long relied on automation systems that process rules-based workflows with limited or no need for complex logic and nuanced judgement. Robotic Process Automation (RPA) has been highly effective at automating repetitive, high-volume tasks such as claim status checks and data entry.
However, its limitations are increasingly apparent. Today’s revenue cycle challenges demand more than just speed and efficiency; they require adaptability, context, and intelligent decision-making.
That’s where agentic AI comes in.
Agentic AI represents a next-generation approach to automation—one that mimics how humans think, make decisions, and interact with systems and people. Unlike RPA, which follows strict, predefined scripts, agentic AI models operate as autonomous agents. They’re context-aware, goal-oriented, and capable of reasoning across complex workflows. For revenue cycle teams under pressure from rising denials, staffing shortages, and shrinking margins, this kind of intelligence isn’t just nice to have—it’s becoming essential.
What Makes Agentic AI Different?
The simplest way to explain agentic AI is to compare it to a seasoned team member—one who not only knows how to complete a task but also when to escalate, adapt, or reprioritize based on changing circumstances. Agentic systems can:
Interpret and act on real-time data from multiple sources
Make decisions without human intervention
Learn from patterns and improve over time
Collaborate with human team members when needed
In practical terms, this means AI can now triage claims, initiate and complete payer calls, route work dynamically, or even autonomously document and code encounters—all with logic and consistency.
Why This Matters for RCM
Healthcare RCM is a perfect candidate for agentic automation because it sits at the intersection of structure and unpredictability. Processes are highly regulated, but real-world conditions vary constantly. Consider these examples:
Accounts receivable: Agentic AI can identify which claims require expert attention and which can be resolved through automation, ensuring staff spend their time where it’s most needed.
Insurance follow-ups: AI agents can navigate payer phone trees, wait on hold, retrieve claim information, and even update the EHR, without tying up human resources.
Denial management: Instead of flagging a denied claim for review, an agentic system can analyze the denial reason, check documentation, and suggest or initiate corrective actions.
These aren’t distant possibilities—they’re already being piloted and implemented in real-world environments.
The Human + Agentic AI Model
It’s important to note that agentic AI is not about replacing people—it’s about augmenting them. The most effective models combine human oversight with AI execution:
Human experts oversee automated workflows, handle edge cases, make nuanced judgment calls, or perform relationship-driven tasks.
AI agents handle high-volume, rule-governed, or low-dollar work with consistency and speed, while equipping staff members with insights and suggested actions.
This hybrid approach doesn’t just improve throughput; it also enhances job satisfaction for teams that no longer spend their days on tedious follow-ups or simple reconciliations.
Getting Started with Agentic AI
For organizations beginning to explore this space, here are a few guiding steps:
Consolidate and clean your data: Fragmented data across EHRs, billing systems, and vendor platforms limits AI effectiveness. Start by creating interoperable, governed data environments.
Identify high-ROI use cases: Look for repeatable processes with moderate complexity and clear financial upside, like denial prediction, prior authorization automation, or A/R follow-ups.
Experiment with short feedback loops: Choose pilots where you can quickly assess ROI and adjust based on results. Don’t aim for perfection—aim for momentum.
Build trust through transparency: Ensure your AI systems are auditable and explainable, especially when financial decisions are being made autonomously.
A Path to Sustainable Margins
Every healthcare leader is being asked to do more with less: deliver care, navigate compliance, and protect financial performance. Those who lead with tech-forward cultures by embracing intelligent automation and prioritizing data cleanliness in their revenue cycle operations are well-positioned to rise to the occasion. In contrast, those who resist innovation due to skepticism or overly protective and risk-averse policies risk falling behind—exposing their financial performance to volatility and long-term disruption.
Agentic AI offers a path forward, not as a magic bullet, but as a powerful tool for reclaiming time, improving accuracy, and aligning resources where they have the most impact.
It’s still early days for agentic AI in healthcare RCM, but the direction is clear. With the right balance of vision and pragmatism, revenue cycle leaders can unlock a new level of operational intelligence and move closer to sustainable, value-driven performance.
We’ve all seen the headlines: AI diagnosing diseases faster than doctors, chatbots offering mental health support, or predictive models guiding treatment plans. Sounds revolutionary, right? And it is. But here’s the catch: are we trusting AI a little too much in healthcare?
As we race towards an AI-powered medical future, we may be overlooking some serious red flags. Trusting AI blindly without transparency, oversight, or ethical clarity could open the door to a public health crisis we’re not prepared to handle.
1. The Seduction of Accuracy: Why We’re Hooked on AI
AI’s ability to process vast datasets, identify patterns, and provide fast results is undeniably powerful. In radiology, for example, AI models can detect lung nodules and fractures with stunning precision. But here’s what often gets buried in the excitement: AI accuracy is context dependent.
If the training data is skewed, incomplete, or unrepresentative, AI can deliver dangerously wrong results. Yet, because it “sounds scientific,” many clinicians and administrators take its output as gospel. That’s not just risky, it’s irresponsible.
2. The Problem of Opacity: When You Can’t Ask “Why?”
AI systems, especially those powered by deep learning, are often called black boxes, you feed in data, get a result, but don’t always know how that result was generated.
In medicine, where accountability and evidence matter, this lack of transparency is a ticking time bomb. If an AI system denies a cancer diagnosis or suggests the wrong dosage, who takes responsibility? You can’t just shrug and say, “The algorithm said so.”
3. Bias in, Bias Out: When AI Reflects the World’s Injustices
Healthcare systems already struggle with inequalities, and AI can unintentionally make them worse. If your algorithm is trained mostly on data from urban, affluent, white populations, it might fail miserably when treating rural patients, minorities, or underrepresented groups.
There have already been real-world examples. AI models giving lower risk scores to Black patients or missing early signs of disease in women. When AI amplifies bias, it’s not just a software flaw—it’s a life-threatening issue.
4. The Illusion of Efficiency: Fast Isn’t Always Better
Hospitals and health systems are eager to cut costs and improve efficiency and AI seems like the perfect solution. Automated diagnostics, virtual assistants, predictive analytics; sounds like a dream.
But in practice, rushing decisions based on AI can lead to misdiagnoses, missed nuances, and overdependence on automation. The human side of medicine (empathy, judgment, contextual decision-making) cannot be replaced by code.
Efficiency without empathy is a dangerous shortcut in healthcare.
5. Security Threats: AI Is a Cyber Target
With AI tools integrated into EHRs, telehealth, and medical devices, the attack surface for cybercriminals has widened dramatically. An AI system trained on patient data becomes a goldmine for hackers.
A compromised algorithm can not only leak sensitive data, it can change how medical decisions are made. Imagine a manipulated AI tool misguiding cancer treatment or altering drug prescriptions. That’s not science fiction, it’s a real risk.
Conclusion: Proceed, But With Caution
AI has the potential to transform healthcare for the better. But only if we treat it as a partner, not a prophet. Blind faith in technology especially in matters of life and death—has never ended well.
As healthcare continues its digital transformation, we must ask tough questions, demand accountability, and design AI systems that serve people first. The future of public health depends on it.
Let’s not sleepwalk into a crisis—let’s build a future where AI and humans work together, not at the cost of one another.
By Michelle Barlow, RN, BSN, Director of Regulatory and Clinical Excellence, Homecare Homebase.
The rising cost of in-facility healthcare, an aging population, and a growing preference for receiving care at home have prompted the home-based care industry to excel. Traditionally, nursing homes were considered the best option for long-term elderly care by healthcare organizations, but the COVID-19 pandemic has since altered this perception, introducing notable benefits and growing demand for home-based care.
However, there is a shortage of in-home caregiving aides and clinicians. This is prompting many home care agencies to adopt end-to-end tech solutions to help streamline daily tasks and caregiver duties. But creating technology for the sake of technology won’t solve these problems.
To recruit quality talent and support existing caregivers, it’s vital to ensure their feedback is built into the design of the software. It needs to be intentional with the end user in mind. This undertaking starts with listening to the people on the front lines, the ones whom the technology directly impacts. Here’s why collaboration between software developers, caregivers, and providers during the product design process matters:
1. Practical Application and Caregiver Feedback
Designing software for healthcare professionals without their feedback or including them in early user testing is simply impractical. Leveraging clinical experience provides a deeper understanding of the software’s impact on patient care that only those working directly with patients can understand. This unique perspective empowers them to identify inefficiencies in existing processes. By working together, caregivers and providers can pinpoint areas where technology can automate tasks and seamlessly integrate them into daily routines.
Product development teams with clinical expertise add an extra layer of understanding. They possess a deep knowledge of the needs, challenges, and treatment plans different patient populations face. They bridge the communication gap, translating caregiver and provider feedback from the language of healthcare into actionable insights that developers can easily grasp and implement.
Software developers must also include providers and caregivers in the testing process to ensure its functionality and usability, as well as identifying any possible challenges that may need to be fixed before a product’s rollout. Providers can identify specific areas for improvement in clinical practices and discover unexpected uses for the product, helping to resolve issues before a broader release.
2. Building a Trustworthy Foundation
When caregivers and providers are actively involved from the beginning, they become invested partners, but this can only be achieved through continuous user feedback so the software is prepared to change as the market inevitably shifts. They understand the product’s purpose and value, encouraging enthusiastic endorsement within their agencies. This fosters user adoption and builds industry-wide credibility for the software. As a result, developers gain invaluable user insights, and the healthcare community receives a solution designed with their specific needs in mind and is applicable in a real-world setting.
3. Eliminating Costly Missteps
No tech developer wants to create a product that nobody wants, or that cannot be integrated into existing workflows. By skipping caregiver and provider input, developers risk creating inefficient software that misses the mark entirely. Collaboration during the design phase helps identify and avoid these pitfalls. By actively listening to providers from the start, developers can create a product that truly aligns with caregiver and patient needs, saving time, money, and dissatisfaction.
Fostering Enduring Partnerships
Software development is a shared and ongoing journey with intricacies that should be tested and updated regularly. To ensure provider feedback is woven into the very fabric of the product, involve them from the outset. Gather insights through surveys and focus groups, keep them engaged during pilot programs, and continuously solicit their thoughts.
This invaluable input will guide product iterations, leading to refined solutions. Comprehensive training and support upon launch will further ensure successful implementation. Both parties should actively contribute ideas – tech vendors must continuously update features based on user feedback, and providers should feel empowered to suggest improvements.
Redefining the Future of Home-Based Care
The future of home-based care is here, and it’s not just about a singular innovation. As we look to use technology responsibly and in a way that enhances human capabilities rather than replacing them, it’s clear that cultivating a powerful, mutually beneficial partnership between developers and those at the heart of care delivery is mission-critical.
Through collaborative effort and strategy, we can design solutions that empower caregivers, optimize workflows, and, ultimately, revolutionize in-home patient care. This is not merely about achieving growth; it’s about crafting a future where exceptional and dignified care flourishes within the comfort of a patient’s home.
Over the past decade, the US healthcare landscape has witnessed the emergence of alternative payment models designed to realign incentives, improve patient access, and stabilize practice finances. Chief among these innovative models are concierge medicine, Direct Primary Care (DPC), and the pay-first approach.
Although each model operates differently, they share a common goal: reducing administrative burden, enhancing patient engagement, and ensuring predictable revenue streams. Understanding their nuances, benefits, and implementation challenges can help practices decide which path best fits their mission and patient population.
Concierge Medicine, sometimes called “boutique” or “retainer” medicine, typically involves patients paying an annual fee, often several thousand dollars, in exchange for enhanced access to their physician. This can include same-day or next-day appointments, longer visit times, 24/7 phone or text access, and comprehensive annual physicals. For physicians, the concierge model offers a reliable source of revenue detached from traditional insurance reimbursement.
This steady income can reduce reliance on high patient volumes, allowing doctors to maintain smaller patient panels and dedicate more time to individualized care. Patients, in turn, enjoy a white-glove experience: fewer waits, more personal attention, and simplified navigation of preventive care.
Despite its advantages, concierge medicine remains accessible primarily to higher-income patients who can afford the retainer fee. Practices evaluating this model must consider patient demographics and local competition. Physicians must be transparent about which services the retainer covers and which remain subject to traditional insurance billing.
Clear contract terms help prevent confusion when patients seek specialists or hospital care outside the concierge arrangement. Additionally, regulatory and legal frameworks governing retainer practices vary by state, so clinics should seek guidance to ensure compliance with fee-splitting and insurance regulations.
Direct Primary Care (DPC) represents a middle ground between concierge medicine and traditional fee-for-service. In DPC, patients pay a flat monthly or annual subscription—typically ranging from $50 to $100 per person—that covers an agreed-upon suite of primary care services. These may include preventive exams, chronic disease management, basic labs, and unlimited office visits. By removing insurance billing for primary care services, DPC practices eliminate much of the administrative overhead associated with coding, claims submission, and payer denials. The model enables physicians to focus on delivering comprehensive care, often with same-day appointments and enhanced access through telehealth or direct messaging.
Unlike concierge medicine, Direct Primary Care is designed to be affordable for a broader patient base, including those with high-deductible insurance plans or no coverage at all. Patients appreciate the predictability of subscription fees, which can replace unpredictable copays and coinsurance charges. For physicians, DPC creates predictable revenue streams while maintaining the flexibility to bill insurance for services outside the primary care scope, such as specialist referrals, imaging, or hospitalizations. Practices considering DPC should carefully size their patient panels to balance access with financial sustainability, as too many subscribers can strain provider capacity and erode the very benefits that make the model attractive.
The Pay-First Model addresses financial sustainability through a different mechanism: point-of-service collections. At its core, pay-first asks patients to pay their copays, deductibles, or estimated out-of-pocket responsibility when they check in, or even in advance via secure online portals. After insurance adjudication, any remaining balance is automatically charged to a credit card on file. By collecting anticipated patient dues upfront, practices can drastically reduce accounts receivable and bad debt write-offs. Staff spend less time on billing follow up and more on patient engagement, while revenue cycles accelerate and cash flow becomes more predictable.
From the patient perspective, pay-first delivers transparency and convenience. When patients understand their financial responsibility before the visit, surprise bills become a thing of the past. Many practices augment this clarity with automated estimates generated from integrated eligibility and benefits platforms, which check coverage in real time. To succeed with pay-first, practices must communicate clearly across multiple channels—phone, text, email, and web—and offer flexible payment options, including online portals, health savings account payments, or payment plans. Training staff to navigate conversations about costs empathetically is crucial to maintaining trust and minimizing friction.
Although these models each offer compelling advantages, practices must carefully align choice of model with their patient population, specialty, and operational capacity. Smaller primary care clinics in underserved areas may find DPC especially well-suited to populations with high-deductible insurance, as the predictable subscription fee encourages regular preventive visits. Specialty practices with stable, affluent patient bases might lean toward concierge medicine, offering a differentiated, service-rich experience. Multi-specialty groups or larger health systems can pilot pay-first for routine outpatient visits, leveraging their administrative infrastructure and digital engagement tools to reduce billing complexity and improve patient satisfaction.
Regardless of model, technology plays a pivotal role in ensuring success. Practices should invest in integrated EHR platforms that streamline scheduling, billing, and documentation for virtual and in-person visits alike. Automated patient portals and mobile apps facilitate pre-visit questionnaires, consent forms, and payment processing. Telehealth capabilities extend reach beyond the conference room, offering virtual check ins and chronic disease monitoring that complement subscription- or retainer-based care. Data analytics tools can track key performance indicators such as patient acquisition costs, no-show rates, revenue per visit, and patient satisfaction, which enables continuous optimization.
Looking ahead, the adoption of concierge medicine, Direct Primary Care, and pay-first models reflects a broader shift toward value-based, patient-centric care. These approaches challenge the status quo of volume-driven reimbursements, incentivizing proactive, relationship-driven engagement over transactional encounters. As policymakers and payers increasingly recognize the importance of preventive care and population health, hybrid models may emerge, blending subscription fees with performance-based incentives for quality metrics. Practices that remain agile, invest in digital infrastructure, and prioritize transparent communication will be best positioned to thrive in this evolving landscape.
Ultimately, the future of U.S. healthcare depends on aligning financial incentives with patient outcomes and experience. Emerging payment models, whether through concierge retainers, DPC subscriptions, or pay-first collections, offer practical pathways to reduce administrative overhead, improve access, and build sustainable practices. By thoughtfully selecting and tailoring these models to fit their unique context, healthcare providers can create resilient, patient-focused practices that stand the test of time.
This Integrated Cloud Email Security (ICES) application is a cloud-based email security solution that supplements the native security of cloud email providers (such as Microsoft 365) using advanced detection techniques to identify malicious emails and suspicious activity.
ICES empowers organizations to identify and address email security vulnerabilities to better defend against today’s threats, such as Business Email Compromise, AI-crafted Phishes, Deepfake media, and more. For partners, this solution provides a valuable addition to their offerings, enhancing their ability to deliver comprehensive security solutions to customers.
Integrated Email Security Solution
The VIPRE Integrated Email Security Solution offers organizations a powerful, all-in-one defense system against today’s most persistent email-based threats. Combining advanced AI-powered detection, comprehensive protection of internal emails, real-time threat intelligence, automated policy enforcement, and seamless Microsoft 365 integration, this comprehensive solution helps businesses protect sensitive communications, block malicious content, and ensure compliance with regulatory requirements.
“We are proud to deliver a fully integrated email security solution that empowers organizations to stay protected against the ever-evolving email threat landscape, without sacrificing simplicity,” said Oliver Paterson, director, product management, at VIPRE Security Group. “In a time when email remains the number one attack vector, this solution ensures our customers have the layered, adaptive protection needed to outpace evolving threats.”
The VIPRE Integrated Email Security Solution is available as a standalone service or as part of VIPRE’s broader suite of cybersecurity offerings. Its flexible deployment and integration capabilities support organizations in building a unified, layered security strategy tailored to their evolving business needs.
By Matthew Bernier, product management director and VP of PayerSync, Rectangle Health.
Healthcare providers are at a defining point, grappling with financial strain, often stemming from outdated and inefficient revenue cycle management (RCM) strategies.
These strategies, often riddled with manual inefficiencies and slow to adapt, are no longer sufficient to navigate the relentless tide of evolving payer regulations, skyrocketing denial rates, and the growing financial burden on patients.
RCM is widely recognized as an essential framework supporting the financial health and operational effectiveness of medical practices. Despite significant advancements in healthcare technology, many reimbursement processes remain outdated, cumbersome, and fragmented. This escalating pressure isn’t just a minor inconvenience; it’s actively eroding reimbursements, stifling cash flow, and ultimately compromising a provider’s ability to deliver essential patient care.
New research from American Express and PYMNTS revealed that 67% of healthcare payer executives reported that their firms’ reliance on manual payment systems is hampering their operational efficiency. Additionally, nearly 74% said that these outdated systems are increasing their exposure to regulatory fines and compliance penalties. Healthcare providers are already feeling the sting, meaning streamlining these processes is vital for redirecting valuable resources toward patient care and clinical services.
The Pitfalls of Outdated Reimbursement Methods
Many inefficiencies originate from continued reliance on traditional payment systems, notably paper checks and standard ACH transfers. While foundational in their own right, these payment methods were not designed to accommodate healthcare’s specialized requirements, such as the secure, compliant transmission of detailed patient remittance information. Providers frequently find themselves manually reconciling Explanation of Payments (EOPs) with deposits, a process prone to delays, errors, and unnecessary complexity.
Although ACH transfers represent a digital improvement over paper checks, standard ACH formats typically cannot include the comprehensive remittance details essential for precise and timely payment reconciliation. Additionally, financial institutions lack the infrastructure and incentives to manage HIPAA-sensitive information securely, adding administrative burdens and complexity for healthcare organizations.
Mounting Financial Pressures on Providers
The financial impact on providers due to outdated reimbursement methods is evident. According to a 2024 survey by Experian Health, 73% of healthcare administrators reported an increase in claim denials, rising from 42% just two years prior.
Several factors contribute to this decline:
Increased claim denials: Providers are seeing higher initial claim denial rates, especially from commercial health plans and Medicare Advantage plans.
Higher patient financial responsibility: The rise in high-deductible health plans and cost-sharing arrangements has placed more financial burden on patients, complicating the collection process.
Bad debt write-offs: Insured patients are increasingly accounting for significant amounts of bad debt, creating additional financial strain on healthcare providers.
Ongoing healthcare staffing shortages only amplify these challenges. Healthcare leaders report severe impacts from staff shortages, with 81% citing delays in care, longer wait times, and reduced access to essential services as significant issues. Providers, already stretched thin, are forced to divert limited resources to manage overdue payments, exacerbating administrative strain and creating uncertainty around cash flows and financial projections.
The Power of Next Generation Payment Rails
Addressing the persistent challenges of healthcare payments, next-generation digital payment rails offer providers a transformative path forward. Unlike standard ACH transfers, these advanced digital rails embed detailed remittance data directly within transactions, providing immediate, automated reconciliation. This integration reduces the time providers spend matching payments to claims, dramatically decreasing accounts receivable (A/R) days.
Providers already leveraging these innovative payment rails have experienced reimbursement processing times shrink from weeks to days. These streamlined systems automatically post reimbursements directly into practice management systems (PMSs) or electronic medical records (EMRs), eliminating manual data entry and reducing costly errors.
Next generation payment solutions meet patients’ evolving expectations. Modern online digital payment portals provide patients with transparent billing, cost estimates, flexible payment options, and insurance information. This is particularly important as nearly seven in 10 Gen Z patients report having payment issues with their latest healthcare service, highlighting a strong preference for convenient, contactless, and online payment methods. For providers, these solutions streamline billing through stored patient payment methods, deliver instant notifications, and offer consistent reporting across all payers, significantly enhancing financial visibility and control.
Digital Reimbursement: Accelerating Cash Flow and Accuracy
To overcome revenue cycle challenges effectively, providers should embrace automation and digitization within their reimbursement workflows. Modern, healthcare-specific digital reimbursement solutions securely integrate detailed, HIPAA-compliant patient data directly into financial transactions. This integration reduces manual reconciliation, enhancing accuracy and accelerating the reimbursement cycle.
Digitally automated reimbursement solutions consolidate various payment forms into a unified system, offering providers real-time transaction visibility and simplified reconciliation. By automating routine administrative tasks, healthcare staff can dedicate more time to high-value activities focused on patient care and practice growth, resulting in improved patient experiences and outcomes.
Additionally, automated reimbursement solutions provide immediate insights into payment statuses, equipping providers with accurate revenue forecasting, efficient budgeting, and proactive financial management.
The Path to Financial Strength
As reimbursement complexity grows, adopting automated and digitally integrated payment systems designed explicitly for healthcare becomes essential. Providers who modernize their reimbursement processes today will position themselves to handle industry challenges more effectively, securing their financial health, enhancing operational efficiency, and ensuring superior patient care for years to come.
Virtual credit card (VCC) payments from insurance companies are on the rise and are often costing practices more than they realize. We sat down with Eric Cohen, CEO of Merchant Advocate, to unpack what providers should know about VCCs, the fees they often don’t see, and how to fight back without switching processors.
Q: What exactly are virtual credit cards, and why are they becoming more common in healthcare reimbursement?
Virtual credit cards are randomly generated, single-use credit card numbers typically issued by an insurance payer or payment aggregator for provider reimbursement. They’re often pitched as a secure and efficient alternative to paper checks or electronic funds transfers (EFTs). For insurance companies, VCCs streamline the payment process, allowing them to earn cashback rewards on the transaction. This makes VCCs attractive for payers, but the convenience comes at a cost to providers.
Q: What kind of costs are we talking about?
Most healthcare providers are unaware that virtual credit card payments can carry processing fees anywhere from 2% to 5%. On average, we see providers paying between an additional 3% to 4% per transaction with VCCs. Over time, those fees add up significantly, especially for high-volume practices.
Q: Isn’t that just the cost of doing business in a digital age?
Not necessarily. That’s a common misconception. The truth is that providers often have a choice, but they don’t realize it. In many states, insurance companies are legally required to offer alternatives to VCCs, including ACH EFT payments, which carry much lower fees, typically just a few cents per transaction. Many insurers still default to VCCs unless the provider explicitly requests something else.
Q: So, if a provider wants to avoid these fees, what should they do first?
Step one is understanding your rights. Several states, including Colorado, have passed legislation that prohibits insurance companies from making VCCs the only reimbursement method. Check with the American Medical Association or your state medical board to find out what the law says in your jurisdiction.
Reviewing your contracts is also crucial. Many providers sign agreements with insurers without realizing that payment terms are included or negotiable. If you’re not sure what your agreement allows, that’s a red flag that warrants a closer review.
Q: What other steps can providers take to reduce or avoid these hidden fees?
Audit your current payments. Understand how you’re getting paid, by whom, and how often. Separate VCCs from EFTs and patient payments. Many practices don’t even realize how much of their reimbursement is tied to VCCs until they do a line-item audit.
Request alternative payment methods. If your state allows it, formally request ACH EFTs from payers instead of accepting VCCs by default. Keep written documentation of those requests and any responses from the payer. If they deny your request without cause, you can file a complaint against the health plan with the Centers for Medicare & Medicaid Services.
Partner with experts. Outside experts can help providers navigate the complexities of payment systems and identify areas where fees can be reduced. These professionals can assist with contract analysis, clarify fee structures, and suggest more cost-effective payment arrangements, all without requiring a change in processors.
Q: Can you share an example of what fee reduction might look like in practice?
Every medical practice is different, but we often find that providers are unaware of how much they’re losing to virtual card fees until they take a closer look. By analyzing how reimbursements come in and working through the details of payer contracts, many practices can shift toward lower-cost payment methods, such as ACH, and significantly reduce overall processing costs. These improvements often don’t require changing processors or overhauling operations, just more transparency and better oversight.
Q: Why isn’t this issue more widely known in the healthcare industry?
I think it’s a combination of opacity and inertia. The payment space is complex and constantly evolving. Most administrators are focused on delivering quality care and managing day-to-day operations, not the nuances of interchange fees. VCCs are also marketed as the default, making them easy to accept and hard to question unless you know what to look for.
Q: Any final advice for healthcare administrators who want to get ahead of this?
Stay informed and proactive. Treat your payment methods like any other vendor or operational expense; you wouldn’t accept a 3% surcharge on your rent or utilities without questioning it. The same scrutiny should apply here. A few small changes could make a big difference to your bottom line.
Health Level Seven International (HL7), a leading global healthcare standards development organization, is pleased to announce the official launch of its HL7 Business Process Modeling (BPM) Community of Practice. Now open for membership, the community is dedicated to advancing interoperability, process consistency, and process automation through the use of formal modeling techniques promoting better modeling, sharing, and execution of clinical and administrative workflows across the healthcare ecosystem.
BPM Community of Practice builds upon three open standards-based languages – referenced together as “BPM+”, and include:
BPMN (Business Process Model and Notation): For prescriptive workflows
CMMN (Case Management Model and Notation): For reactive activities
DMN (Decision Model and Notation): For complex decision-making rules
The use of these standards, in concert, allows inherent ambiguities in natural-language guidelines to be clarified, providing precise, automatable guidance to improve care quality and consistency. Organizations use BPM+ to model and streamline processes, ensuring accurate and scalable healthcare delivery, process consistency, comparability, and repeatability.
“HL7’s focus is on bringing together communities to advance all aspects of interoperability, and that includes workflow and care processes,” said Ken Rubin, Community Coordinator of the HL7 BPM Community of Practice. “This launch marks an important step in providing the healthcare industry with tools, models, and frameworks to manage care processes more effectively, consistently, and collaboratively.”
The BPM Community of Practice builds on years of foundational work in clinical business process modeling and is now positioned to contribute meaningfully to FHIR-based implementation efforts. Members will collaborate to support real-world needs like shared care planning, cross-organizational process execution, human and system interaction modeling, and automation through service orchestration and decision support.
“Welcoming the BPM Community of Practice into our organization was a natural fit. We are excited about the possibilities it brings to leverage and build upon FHIR to enable and support shared care, consistency, and reliability in healthcare practices,” said Dr. Charles Jaffe, CEO of HL7 International. “Moving forward, our industry needs solutions that can effectively manage interactions between humans, systems, and AI to support process portability and seamless care.”
The BPM Community of Practice offers an open environment where stakeholders from healthcare, health IT, academia, and government can collaborate to shape how workflows are represented and executed within the FHIR ecosystem. It provides a platform for those working in this space to collaborate, learn from one another, collect and document best practices, and engage with peer experts.
“The HL7 BPM Community of Practice is a game-changer for aligning complex healthcare workflows with the precision and scalability of FHIR,” said Dr. Thomas Chon, CEO of Tetra Fields LLC. “By uniting leading modeling standards, this community empowers collaborative, interoperable solutions that improve care coordination and execution across the healthcare system.”
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