Health claims clearinghouse and payment transactions vendor InstaMed recently released its “Trends in Healthcare Payment: 2012,” updating its annual report. Based on transactions data and survey responses from providers, patients and payers, the report reveals current trends and drivers in payment transactions. Highlights follow.
Changing Insurance Landscape
Patients are increasingly responsible for health payments. Enrollment in high-deductible health plans has ballooned from 1 million members to more than 11 million since 2005.
Changing Revenue Sources
With the growth of high-deductible plans, providers are now getting more payments directly from patients, rather than health plans. In 2010, payers paid providers an average of 23% of the billed charges, which decreased to 20% in 2012, due to increased patient responsibility, according to InstaMed.
Impact of Health Reform
Beginning in 2014, all payers must support electronic remittance advice and funds transfers services. In 2012, about half of all payer payments were disbursed via EFT, directly into providers’ accounts.
Preparing for EFT
About two-thirds of payers offer ERA/EFT to providers. Those that don’t cite the cost of the service as the main barrier. But 76% of payers said they are preparing for the upcoming ERA/EFT mandate.
Preparing for the Future
Even with EFT, providers will need to streamline collection efforts from patients in order to maintain efficiency. That’s particularly true with some 30 million previously uninsured people expected to begin to receive coverage under health reform in 2014.
Room for Improvement
In 2012, only 41% of providers collected patient payments at the point of service. Reason: uncertainty about the amount due and patient resistance to pay. For the vast majority of providers (83%), it took more than one month to collect from patients after claim adjudication in 2012, says InstaMed.
While 62% of patients said they normally paid bills online, only 4% said they received healthcare bills via e-mail in 2012. Nearly three-fourths (72%) of patients would welcome online bill payment options. To gain consumer confidence in such transactions, the industry will need to assure data security, InstaMed says.