Virtual Payments: Not Just a Phase in Healthcare

Virtual payments are an emerging payment method for payers to send payments to providers using the card networks. These payments are more commonly known as “virtual cards,” since the recipient can process them just like a credit card.

Thirty-seven percent of providers indicated that they received virtual payments from some payers.

This statistic accurately demonstrates what many providers are currently experiencing: Virtual payments are increasingly leveraged by payers as an alternative to mailing paper checks. While many believe that virtual payments are

Tagged healthcare payments, patient payments, payer-to-provider payments, payers

Key Considerations for Achieving ERA/EFT

On January 1, 2014, all payers will be required to support electronic funds transfer (EFT) and electronic remittance advice (ERA). When evaluating how to achieve ERA/EFT, one of the first decisions a payer will need to make is to “build or buy” – whether to use internal resources to build ERA/EFT capability or to work with a third-party vendor.

Regardless of which model a payer follows to achieve ERA/EFT, there are several key considerations that need to be included in the

Tagged Administrative Costs, Affordable Care Act, Best Practice, CAQH, Compliance, CORE, ERA/EFT, healthcare payments, healthcare reform, payer-to-provider payments

Going Electronic? How to Get Your Providers on Board

In 2020, 26% of surveyed healthcare payers said that more than half of their provider networks still don’t accept ERA/EFT (Trends in Healthcare Payments Annual Report). Despite the HHS operating rule on EFT standards which went into effect in 2014 and mandated that payers had to adopt ERA/EFT, 84% of surveyed healthcare providers indicated they continue to receive paper checks from one or more payers.

The sooner providers accept electronic payments, the more money payers and providers can save. So how can you

Tagged Administrative Costs, Best Practice, Compliance, ERA/EFT, healthcare payments, healthcare reform, payer-to-provider payments, payers, reconciliation, remittance

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

What the New EFT Regulations Mean for You

Guest Blogger: Bill Marvin, President & CEO, InstaMed

In an earlier post, I commented on the HHS interim final rule adopting electronic funds transfer (EFT) standards, which was released in January 2012. In the post, I outlined the following changes needed in order for the new EFT regulations to truly improve efficiency and deliver cost savings for healthcare payers and their provider networks:

1. Add a Trace Number Requirement

The rule should require that the EFT and the electronic remittance advice (ERA) have

Tagged Administrative Costs, Affordable Care Act, Best Practice, CAQH, Compliance, CORE, ERA/EFT, healthcare payments, healthcare reform, Medical Loss Ratio, patient responsibility, payer-to-provider payments, payers, providers, reconciliation, remittance, reporting

Why the New EFT Rule Could Have Been Better

Guest Blogger: Bill Marvin, President & CEO, InstaMed

Recently, the Centers for Medicare & Medicaid Services (CMS) announced a final rule adopting electronic funds transfer (EFT) standards, which are part of the ACA provisions that call for improved administrative efficiency. While this rule is just one piece of the ACA operating rules, the adoption of the rule for EFT standards lays a positive foundation for the future of both EFT and ERA (electronic remittance advice). However, a couple of serious flaws

Tagged Administrative Costs, Affordable Care Act, Best Practice, ERA/EFT, healthcare reform, payer-to-provider payments, payers, providers, reconciliation, remittance

8 Things ACOs Need to Know About Healthcare Payments

What Is an ACO?

An ACO (accountable care organization) is a healthcare organization made up of providers and payers who come together to give coordinated, patient-centered care. In the public sector, ACOs earn incentives for delivering high-quality care and reducing healthcare costs for Medicare and Medicaid patients. In the private sector, ACOs focus on achieving a high level of wellness and satisfaction for all patients.

What You Should Know About ACO Payments:

1. Increase focus on collecting from patients. As providers work to

Tagged ACO, EHNAC, ERA/EFT, healthcare payments, HIPAA, integrated healthcare payments, patient responsibility, payer-to-provider payments, payers, payment assurance, PCI-DSS, private cloud, providers, reconciliation, remittance

Choosing the Right Clearinghouse: 5 Essential Qualities

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In the healthcare industry, the clearinghouse you work with has a huge impact on your business. The more efficiently your clearinghouse processes and returns your information, the faster you will get paid, and the more payments you will collect.

To gain insight into what providers need from a clearinghouse, we interviewed Kevin Milam, owner of The Billing Center, which does billing, consulting and accrediting for

Tagged Billing, Claim Status, Claims, Clearinghouse, Compliance, EHNAC, healthcare payments, increase collections, InstaMed Network, payer-to-provider payments, payment, payment assurance, private cloud, providers, reconciliation, remittance, reporting

Electronic Payments: 4 Requirements to Integrate EFT with ERA

Healthcare reform is a major factor driving change in payer-to-provider payments, including the medical loss ratio (MLR) requirement in PPACA. To reduce administrative costs and meet the MLR mandate, payers are implementing more efficient payment delivery methods. One such method is the offering of ERA/EFT, which combines both the payment and the healthcare payment information to enable provider funding, posting and reconciliation. While many payers have been sending providers ERAs (electronic remittance advice) for years, it’s time for payers to

Tagged Affordable Care Act, CAQH, Compliance, CORE, EHNAC, ERA/EFT, healthcare payments, healthcare reform, HIPAA, ICD-10, Medical Loss Ratio, NACHA, payer-to-provider payments, payers, PCI, providers, remittance, SSAE 16

Blog Post Topic: payer-to-provider payments