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
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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
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,
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,
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
Healthcare reform is a major factor driving change in payer-to-provider payments, including the medical loss ratio (MLR) requirement in PPACA. To reduce administrative costs and meet the MLR mandate, payers are implementing more efficient payment delivery methods. One such method is the offering of ERA/EFT, which combines both the payment and the healthcare payment information to enable provider funding, posting and reconciliation. While many payers have been sending providers ERAs (electronic remittance advice) for years, it’s time for payers to