Now that we are certain about new regulatory mandates and the direction of healthcare in the U.S., the industry can refocus its efforts on preparing for the road ahead. Here’s a look at what we can expect in healthcare payments in the next decade:
More Coverage = More Patient Payments
Approximately 30 million uninsured Americans will begin to receive healthcare coverage in 2014. While the enrollment process will take multiple years, we believe that the majority of this group will receive coverage by 2016. This means that more patients will receive healthcare services, and millions of patient payment transactions will be added to the U.S. healthcare system. To prepare for this increase in patient volume, providers will need to implement more efficient ways to collect from patients.
For providers to be able to collect patient payments efficiently, checking eligibility during or prior to a patient visit will be necessary. Additionally, providers will need to offer convenient, consumer-friendly payment options that give patients more flexibility. According to the 2011 Trends in Healthcare Payments Annual Report, online patient payments tripled and payments made via payment plans doubled from 2009 to 2011. As more providers start to offer their patients these options in order to collect more patient payments, this trend will continue in the coming years.
Push for Payer-Provider Interoperability
Under the medical loss ratio (MLR) mandate, payers will need to find ways to reduce administrative costs, especially as the total dollar volume of claim payments increases by billions. Interoperability will be crucial in order to improve efficiency and lower costs in the payer-to-provider payments process, especially for ACOs.
One method to achieve greater efficiency is to deliver Integrated ERA/EFT® (electronic remittance advice/electronic funds transfer), which combines both the payment and the healthcare payment information to enable auto posting and reconciliation. While many payers have been sending providers ERAs for years, delivering payments via EFT (and integrating the ERA with the EFT) has caught on more recently. Since 2009, the number of payer payments made via EFT – in comparison to the number made via paper check – has increased by over 30 percent. In the future, payers will continue to improve efficiency by connecting with my providers to deliver ERA/EFT in order to meet the new mandate.
Change Is Coming Now
Although the new reform mandates will not go into effect until 2014, payer and provider organizations already have begun to make investments to comply with the mandates, so the industry can expect to see changes now. As organizations implement business changes to improve efficiency and meet PPACA mandates, it is crucial to leverage integrated technology that meets the highest levels of healthcare payment compliance, is hosted on a private cloud and connects all constituents of the healthcare payments process, including providers, payers, patients and banks.