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July Tips & Tricks

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Tagged Eligibility, payment plans, remittance

How to Handle Patient Refunds: Best Practices for Providers

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Healthcare payments are complex, making it hard to determine the exact amount a patient will owe. This can lead to overpayment. Here are tips for how to create a positive experience when issuing patient refunds.

Why Are There Refunds in Healthcare?

Many factors determine patient payment responsibility, such as patient health benefits, provider contracted rates with a health insurer, discounts and more. When the sources for

Tagged Eligibility, healthcare consumerism, patient estimation

91^% of Consumers Are Demanding Price Transparency

The patient’s role in the healthcare payments process has evolved drastically. Ten to twenty years ago, payers and providers managed benefit and care decisions for their patients. Patients relied mainly on their health plan and geography to determine which providers to visit; and payment for services, for the most part, was handled between payers and providers.

Today, healthcare is in the midst of a shift towards a consumer-centric model, and in the process, patients have become empowered consumers who are in

Tagged Eligibility, healthcare consumerism, patient responsibility

Clearinghouses are Becoming Obsolete

Recent healthcare news announcements indicate that another major clearinghouse has disappeared. This is a trend that started a few years ago and will continue. In fact, of the top clearinghouses from five years ago, only a portion are still in business, some of which are in the process of exiting the business through strategic sales by their equity investors.

Why are clearinghouses disappearing?

Technology Barriers
One of the major factors contributing to the disappearance of clearinghouses is the fact that most clearinghouses are

Tagged Claim Status, Claims, Clearinghouse, Compliance, Eligibility, HIPAA, integrated healthcare payments, remittance

Finding Payment Assurance with Smart Big Data

Smart Big Data has the capability to transform the collection process in healthcare. By using Smart Big Data to trigger automated processes and real-time decisions at the staff level in daily operations, providers can collect patient payments efficiently, navigate the changes facing the healthcare industry – and ultimately, to thrive.

Finding Payment Assurance in the Healthcare Industry

When you stay at a hotel, are you able to check in without giving your payment card? Of course not. However, patients receive access to

Tagged Administrative Costs, Analytics, Automatic Payment Collection, Eligibility, increase collections, patient responsibility, smart big data

Communication: The Key to Collecting More

With the increase in consumer-directed healthcare, patient payments are becoming a more important part of healthcare provider revenue. However, as consumers, patients are accustomed to having a clear understanding of the amount owed prior to making a purchase. Too often in the healthcare industry, patients are clueless about their payment responsibility until they receive a statement. And when patients are confused or uninformed, they are less likely to pay.

Faced with the challenge of collecting more patient payments, Canopy Partners, a

Tagged Affordable Care Act, Best Practice, Consumerism, Eligibility, healthcare payments, increase collections, patient estimation, patient payments, patient responsibility, payment assurance

Enhance the Provider Experience: Deliver Payment Assurance

In an earlier post, we discussed one of the major threats to the payer-provider relationship: the provider’s lack of payment assurance. This threat poses an opportunity to payers to give their provider networks the tools needed to achieve payment assurance. In our previous post, we gave tips for payers to deliver payment assurance to their providers. Below, we’ve included a graphic of the Payment Assurance Framework to demonstrate how payers can deliver payment assurance to providers in each step of the healthcare

Tagged Administrative Costs, Best Practice, Claims, Clearinghouse, Eligibility, ERA/EFT, healthcare payments, patient estimation, patient payments, patient responsibility, payer-to-provider payments, payers, remittance

How to Keep Your Provider Network Happy

For a healthcare payer’s provider network, the process to get paid has always been a challenge. The steps providers take each day, from verifying eligibility and submitting claims, to receiving and reconciling payments, are filled with manual work, paper, errors and delays. As a result, the fragmented, time-consuming and often stressful process to collect payments is adding a lot of cost pressure on providers.

New healthcare reform mandates also put pressure on providers to find ways to get paid more efficiently.

Tagged Administrative Costs, Affordable Care Act, Best Practice, Eligibility, ERA/EFT, healthcare payments, healthcare reform, increase collections, patient estimation, payer-to-provider payments, payers, payment assurance, payment strategies, private cloud, providers, reconciliation, remittance

Top 3 Misconceptions of Collecting from Patients

Many healthcare providers are concerned about the impact to their businesses that will result under PPACA. Much of this concern is due to the additional 20 to 30 million uninsured Americans that will begin to receive new healthcare coverage in 2014. With more patients eligible to receive healthcare services, and hundreds of millions of patient payments transactions being added to the U.S. healthcare system, the difficulties providers face with patient collections is becoming a high priority issue.

Shifting the focus to

Tagged Administrative Costs, Affordable Care Act, Best Practice, Compliance, Consumerism, Eligibility, healthcare payments, healthcare reform, increase collections, patient bad debt, patient estimation, patient payments, patient responsibility, payment, payment assurance, payment card, payment strategies, PCI-DSS, providers

Steps to Payment Assurance: A New Model for Healthcare Providers

Think of the payment assurance that Best Buy has in a payment transaction: it allows a consumer to walk out of its store with a thousand-dollar television, even though the payment is not yet in the company’s bank account in the form of available funds. The only thing Best Buy has to fall back on is its trust in an authorization, delivered by a payments network, after a consumer’s payment card is processed. Imagine telling Sam Walton in 1960 that

Tagged Claims, Consumerism, Eligibility, ERA/EFT, healthcare payments, increase collections, integrated healthcare payments, patient estimation, patient payments, patient responsibility, payers, payment assurance, payment strategies, providers

Blog Post Topic: Eligibility