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
The increase in self-pay patients and rising operational costs are driving healthcare providers to seek out tools and strategies to operate more efficiently and collect more from patients. Depending on your current processes to collect, there are various changes you can make that can have a significant impact on the amount collected and the time and costs spent to collect. Below are three common process issues that billing service Medical Management Corporation of America (MMCOA) faced with its providers, and
Last year, the majority of surveyed healthcare payers said that less than half of their provider networks did not accept ERA or EFT (read more: 2011 Trends in Healthcare Payments Annual Report). Of the providers who did not accept ERA or EFT during the time of this survey, nearly half said the reason was that they simply preferred paper.
However, according to the HHS interim final rule on EFT standards, payers will need to adopt ERA/EFT by January 1, 2014; and,
As healthcare providers rely more on patients for revenue, many have started to use more patient-centered strategies, like payment plans, to collect payments. But to ensure you’re improving processes for your organization and for your patients, you need to make sure best practices and policies are in place.
A Growing Trend
Data from the 2011 Trends in Healthcare Payments Report shows that the use of payment plans for healthcare payments has doubled since 2009. From the same report, 63 percent of surveyed
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
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.
The term “administrative efficiency” has been popping up everywhere in the healthcare industry lately. Most provider organizations, from the solo-physician practice to the large health system, should know that they need to make strides to achieve administrative efficiency. However, how can you measure efficiency to tell if you’ve achieved it, or if your administration is still inefficient?
Faced with these questions, Judy Downing, the Billing Manager at Holly Springs Pediatrics, decided to quantify inefficiency in her practice by identifying her greatest
With new regulatory mandates like the medical loss ratio (MLR) pressuring the healthcare industry to improve efficiency, payers and emerging ACOs are looking at ways to reduce administrative costs. For many organizations, one of the more obvious areas in need for greater efficiency is the call center.
In the last decade, the increase in provider call volume has become a growing concern (see: “Health Insurance Call Volume Increasing”). In fact, according to the 2011 Trends in Healthcare Payments Annual Report, call
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
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