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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 improve efficiency and the patient experience, they will need to focus on meeting the payment expectations that patients have developed as consumers. Among these expectations are having the ability to use preferred payment methods, such as payment cards and online payments, and being proactively notified of payment due dates.

2. Facilitate efficient patient payments with interoperability. As various providers and payers work together to deliver accountable care, they will need to use integrated solutions using open technology standards to share patient demographics information. ACOs will also need to streamline the processes to collect, post and reconcile payments leveraging a secure, private cloud.

3. Offer payment transparency to patients. To efficiently collect from patients, ACOs need to set payment expectations with patients at the point of service so patients understand their payment responsibility as well as the terms and timing of the payment process before leaving the provider office.

4. Establish patient interaction policies. As ACOs focus more on patient-centered care, providers will need to train staff on patient interaction policies that focus on listening to the patient, empathizing with the patient, agreeing on the problem and partnering on a solution.

5. Emphasize security and compliance. The necessity for security and compliance will become more prominent, as various providers and payers begin working together and sharing information. All healthcare and payment information should be managed through a secure, private cloud network that is not only compliant but also independently certified and audited against the Payment Card Industry Data Security Standards (PCI-DSS) and HIPAA (check MasterCard, Visa and EHNAC for a list of independently certified solutions/vendors).

6. Achieve payment assurance to reduce operational costs. The costs to collect from patients are three to five times greater than the costs to collect from payers. And these efforts have brought minimal success, as, according to McKinsey Quarterly research, providers wrote off more than $65 billion due to patient bad debt in 2010. ACOs need to implement the required tools, policies and processes in order to achieve payment assurance and keep costs low.

7. Improve operational efficiency with comprehensive reporting. Having 24/7 access to detailed and customizable reports and dashboards on all healthcare and payment data – hosted in a secure, private cloud – will make the payment process more efficient and accurate.

8. Receive integrated electronic payments and remittances. ACOs will need to focus on processing payer payments efficiently as well to keep costs low. Electronic funds transfer (EFT) integrated with the electronic remittance advice (ERA) will enable efficient funding, posting and reconciliation.

Additional Resources:

Centers for Medicare and Medicaid Services: ACOs
U.S. Department of Health and Human Services: ACO Fact Sheets
Healthcare.gov ACO Overview

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