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?
One of the major factors contributing to the disappearance of clearinghouses is the fact that most clearinghouses are
Recently, we posted a list of five things that payers can do now to prepare for upcoming reform mandates (click here to read the post). This post emphasizes the importance of collaborating with other organizations like clearinghouses, trading partners and vendors, in order to achieve compliance with the mandated CAQH CORE Operating Rules. These relationships are crucial regardless of the approach payers take to achieve compliance.
Below is an outline of the three main models payers can use to meet the
What Are Operating Rules?
Under the Patient Protection and Affordable Care Act (PPACA), the Operating Rules (developed by CAQH CORE) define the guidelines and standards for making electronic healthcare transactions more predictable and consistent, so the industry can be more efficient.
Upcoming mandated Operating Rules include:
Eligibility and Claim Status: Phases I and II
Deadline for payer compliance: January 1, 2013
Why providers should care:
With mandated standards for electronic eligibility transactions, it will be easier for providers to connect to payers to verify patient eligibility
What’s ahead for payers?
On January 1, 2013, payers will be required to meet the first set of mandated operating rules for Eligibility and Claim Status, under the Patient Protection and Affordable Care Act (PPACA). Click here to view the complete set of CAQH CORE Eligibility and Claim Status Operating Rules.
What can payers do to prepare?
1. Focus on Education
Frequently, half the battle of preparing for mandates is gathering all of the information you need. CAQH CORE released an analysis and planning
This webinar has already occurred.
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Check back for upcoming webinars in the CAQH and InstaMed Webinar Series!
Don’t miss the latest webinar in the CAQH and InstaMed Webinar Series: Are You Prepared for Federally Mandated Operating Rules? Lessons Learned and Best Practices for Implementation
The deadlines for implementing federally mandated operating rules are fast approaching for payers, providers and vendors. Is your organization prepared?
In this webinar, hosted by CAQH and InstaMed, you will learn:
How payers, providers and vendors can
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
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
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
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