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July Tips & Tricks
Refunds in healthcare are hard to eliminate completely. With the increase in patient payment responsibility due to the growth of high deductible health plans, providers are collecting more from patients than ever before. New technologies and better awareness about patient responsibility have helped providers improve the ways they collect. However, the complexities that are inherent in healthcare payments make it difficult to determine the exact amount a patient will owe, which can result in over-payment. Some of the most common
The patient’s role in the healthcare payments process has evolved drastically. Ten to twenty years ago, payers and providers managed benefit and care decisions for their patients. Patients relied mainly on their health plan and geography to determine which providers to visit; and payment for services, for the most part, was handled between payers and providers.
Today, healthcare is in the midst of a shift towards a consumer-centric model, and in the process, patients have become empowered consumers who are in
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
In our last post, we stated that Smart Big Data has the capability to transform the collection process in healthcare. By using Smart Big Data to trigger automated processes and real-time decisions at the staff level in daily operations, providers can collect patient payments efficiently, navigate the changes facing the healthcare industry – and ultimately, to thrive.
Finding Payment Assurance in the Healthcare Industry
When you stay at a hotel, are you able to check in without giving your payment card? Of
As healthcare reform adds millions of new consumers to the U.S. healthcare system and deductibles continue to rise, providers must operate more efficiently to keep administrative costs low and collect more from patients. Many industry experts believe that the recent influx of data and analytics due to innovation in healthcare technology, or Big Data, will give all healthcare organizations the ability to navigate the changes – and ultimately, to thrive. In fact, a recent McKinsey report estimates that Big Data
With the increase in consumer-directed healthcare, patient payments are becoming a more important part of healthcare provider revenue. However, as consumers, patients are accustomed to having a clear understanding of the amount owed prior to making a purchase. Too often in the healthcare industry, patients are clueless about their payment responsibility until they receive a statement. And when patients are confused or uninformed, they are less likely to pay.
Faced with the challenge of collecting more patient payments, Canopy Partners, a
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