November is a time to reflect and give thanks for all the good things in our lives. As a security officer, I am additionally thankful for accomplishments in the field of security and compliance that help us better protect payment data and prevent data breaches in healthcare. Around this time four years ago, we were not so thankful for the massive breach that affected Target stores and compromised the credit and debit card information of 110 million consumers – right
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
A previous post covered how consumerism is impacting the healthcare payments industry and detailed how payers and providers can work together to take advantage of this trend.
However, the rise of consumerism in the healthcare industry presents unique challenges for payers to engage their members, which they must adequately prepare for – or risk consumer dissatisfaction and lost revenue.
Risks and Opportunities of Healthcare Consumerism for Payers
A decade ago, payers and employers managed almost all of the health benefit decisions for patients. As
In 2014, all payers will be federally mandated to support electronic funds transfer (EFT) and electronic remittance advice (ERA) in accordance with the requirements specified in the CAQH CORE Operating Rules. Providers may be wondering how this mandate will affect payer payments and what you must do to be compliant.
Under the mandate, providers have no obligation to accept ERA/EFT from payers. However, the mandate enables providers to improve efficiency and reduce administrative costs. Read on to learn more about how
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
In 2020, 26% of surveyed healthcare payers said that more than half of their provider networks still don’t accept ERA/EFT (read more: Trends in Healthcare Payments Annual Report). Despite the HHS operating rule on EFT standards which went into effect in 2014 and mandated that payers had to adopt ERA/EFT, 84% of surveyed healthcare providers indicated they continue to receive paper checks from one or more payers.
The sooner providers accept electronic payments, the more money payers and providers can save. So how
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
Guest Blogger: Chris Seib, Co-Founder & CTO, InstaMed
Last week, I highlighted some common oversights by businesses when leveraging a private cloud that increase the risk of long-term data outages, and detailed the best practices and tips to use in discussions with current or potential vendor partners in order to protect your business. Below is Part 2 of this post, focusing on disaster recovery, business continuity and security.
Even with high degrees of local redundancy in a private cloud data center,