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Clearinghouses are Becoming Obsolete

Recent healthcare news announcements indicate that another major clearinghouse has disappeared. This is a trend that started a few years ago and will continue. In fact, of the top clearinghouses from five years ago, only a portion are still in business, some of which are in the process of exiting the business through strategic sales by their equity investors.

Why are clearinghouses disappearing?

Technology Barriers
One of the major factors contributing to the disappearance of clearinghouses is the fact that most clearinghouses are

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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

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Hold the Phone! Tips on Reducing Call Center Volume

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

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Achieving Success with Integrated Healthcare Payments

Traditionally, the end-to-end healthcare payments process – from submitting claims to receiving, posting and reconciling payments – has been disjointed and manual, requiring a great deal of paper and leading to errors and delays in payment.  However, as providers continue to feel pressure to reduce costs, leveraging integrated technology to streamline these processes is becoming increasingly important.  Here’s Eastside Pediatrics’ story and the success they achieved with integrated healthcare payments:

A Series of Problems

Inefficient Claims and Remittance Management Processes

On an

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Steps to Payment Assurance: A New Model for Healthcare Providers

Think of the payment assurance that Best Buy has in a payment transaction: it allows a consumer to walk out of its store with a thousand-dollar television, even though the payment is not yet in the company’s bank account in the form of available funds. The only thing Best Buy has to fall back on is its trust in an authorization, delivered by a payments network, after a consumer’s payment card is processed. Imagine telling Sam Walton in 1960 that

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Real-Time Adjudication – Is This the Silver Bullet?

Over the past 10 years, one of the top administrative priorities for the healthcare industry has been the development of real-time adjudication (RTA) for healthcare claims. By 2005, the RTA effort had attracted a great deal of attention and effort across the industry. However, five years later, the results delivered have been underwhelming for both providers and payers.

The Core Problems

Although RTA makes sense from a high-level standpoint, the healthcare transaction process has nuances, both from a technology and business perspective.

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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

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Payment Assurance Level One Certified: Austintown Pediatrics

Austintown Pediatrics, a solo pediatrics practice in Austintown, Ohio, has achieved Payment Assurance Level One, reducing its patient bad debt by 50% and cutting payment processing time by 50%.

Here’s Austintown Pediatrics’ story:

The Issues Behind the Business Problems

Lack of Vendor Integration
Austintown Pediatrics leveraged a third-party billing company to manage payer and patient payments; however, the lack of integration with its practice management system led to inefficient processes, reconciliation difficulties and increased patient bad debt.

Lack of Claims and Payment Visibility
Without integration, the

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