Tag: healthcare payments

Payment Integrity In The U.S.: Uncover the “Why”

Ryan Mooney

By Ryan Mooney, general manager, Source Division, HealthEdge.

In our healthcare ecosystem, waste, fraud and abuse run rampant: in 2020 alone, healthcare spending in the U.S. exceeded $4 trillion, and estimates suggest about a quarter of that was attributed to waste. What this tells us is that an increased focus on payment integrity – and in particular, fixing its traditionally disparate practices – has the potential to greatly benefit payers, providers, and ultimately members.

At its core, payment integrity is the process by which stakeholders ensure healthcare claims are paid properly, both pre- and post-pay. It encompasses determining the correct party, membership eligibility, contractual adherence, and fraud, waste and abuse detection and prevention. In recent years, as healthcare spending continues to skyrocket, payment integrity has received more attention – and investment – than ever. And yet, it leaves much to be desired.

The Current State of Payment Integrity

A comprehensive payment integrity strategy is key to lowering costs and achieving higher quality of care for members, but the systems in place are far from perfect. With over 24 years working in payment integrity, throughout this experience I’ve found it nearly impossible not to run into issues within the system. As it stands, many parties focus on enriching the contingency model versus solving the problem. Structurally, the contingency model is flawed: when the vendor gets paid according to the quantity of errors they find, the core problem will continue, as these parties are incentivized to identify what is incorrect rather than why.

Our 2021 Voice of the Market survey of over 200 health insurance executives found that payment accuracy would help reduce administrative costs at their organization, directly impacting savings that can be reallocated for other business priorities such as considering partnerships, acquisitions, or investing in a new geography or line of business. This represents a substantial shift from the past, demonstrating how stakeholders today want to take advantage of all available resources to expand in the current landscape.

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The Dos and Don’ts of Digital Healthcare Payments

By Alison Arthur, product and content marketing manager, Alacriti.

Stock, Iphone, Business, Mobile, PhoneThe financial well-being of healthcare organizations depends on steady, predictable revenue from their patients. However, healthcare payments are often impacted by a number of financial factors including insurance, co-payments, deductibles, and co-insurance.

Research from TransUnion shows that patients are becoming increasingly responsible for out-of-pocket healthcare expenditures. This means that the possibility of missed bill payments can increase as well. Healthcare providers know that sending unpaid bills to collections can be a significant expense and even lead to costly write-offs that negatively impact the bottom line.

How can healthcare organizations increase the likelihood of collecting patient payments on-time and in-full? Digital bill presentment and electronic payment technology can be a chief facilitator of timely bill payments. Here are some dos and don’ts for healthcare organizations to consider when adopting an electronic bill presentment and payment (EBPP) solution.

Do allow patients to personalize their digital bill payments experience.

Consumers are growing more accustomed to electronic payments in all aspects of their lives. However, many healthcare providers still aren’t equipped to accept online payments from their patients. This continued reliance on in-person payments, agent-assisted transactions, and mailed payments can put a strain on internal resources that costs both time and money. In addition, there are security and compliance implications when employees handle sensitive payment information directly from patients.

EBPP technology can provide patients 24/7 accessibility to their accounts, meaning that patient payments no longer need to be processed exclusively during office hours. These payments can be made using a variety of digital channels that are aligned with patients’ preferences including mobile devices, text messages, and intelligent personal assistants like Amazon Alexa and Google Assistant.

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Trends in Consumer Healthcare Payments

The healthcare payments market is growing rapidly and is estimated to reach $5 trillion by 2022 as a total of both payer and consumer payments. The fastest growing portion of the market is payments from consumers for healthcare services and health plan premiums as a result of shifting payment responsibility and changes because of health reform.

However, the healthcare industry is struggling to address the new role of consumers in the payments process with more than 30 percent of healthcare dollars considered to be wasted because of inefficient, disjointed payment processing and costs associated with paper-based billing and administrative processes. These costs are expected to continue to increase unless the healthcare industry recognizes and addresses the critical role of consumer choice and the impact of the digital economy on payment options.

These latest trends and best practices presented in InstaMed’s Trends in Healthcare Payments Annual Report 2014 outline a critical need for healthcare industry professionals to focus on consumer preferences and their emerging role in the payments process. Healthcare providers and payers who offer consumers preferred payment methods, including card payments and online payments, reduce confusion and ultimately increase collections. Additionally, new electronic payment channels, such as mobile payments and Apple Pay, will further accommodate consumers’ expectations for simple billing and convenient ways to pay. A focus on streamlining the consumer payment experience will improve collection rates, increase consumer satisfaction, and enhance profitability and cash flow.

The following infographic illustrates the top trends, industry challenges and best practices to enable healthcare organizations to adapt to the future of healthcare payments. For more information, download the full report: www.instamed.com/trends.

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