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
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.
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 providers across several states. We came up with five essential qualities to look for when researching
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