Why Are Payers Still Talking About ERA/EFT Adoption?

It sounds like a great achievement – 80 percent of dollar volume sent as ERA/EFT to providers! You’re only 20 percent away from full ERA/EFT adoption, right? Not quite. Some in the industry would have you believe they have achieved huge milestones when it comes to ERA/EFT adoption, but usually the achievements are quantified in dollar volume. ERA/EFT adoption is still low, as 88 percent of providers report receiving paper payments from one or more of their payers. So while

Tagged ERA/EFT

Latest Trends and Practices for Payers to Prepare for the Future

A previous post detailed the latest trends in healthcare payments impacting how providers do business and best practices for providers to meet those challenges. However, the latest trends in healthcare payments present unique challenges for payers, which they must adequately prepare for – or risk consumer dissatisfaction and lost revenue.

Data from the 2013 Trends in Healthcare Payments Annual Report demonstrates that healthcare payments industry is evolving and outlines how payers can manage these changes. In particular, healthcare consumerism and provider

Tagged Best Practice, CAQH, Consumerism, ERA/EFT, healthcare payments, payers

ERA/EFT Mandate: Impacts to Providers

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

Tagged Administrative Costs, Best Practice, CAQH, Compliance, ERA/EFT, payers, providers

Key Considerations for Achieving ERA/EFT

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

Tagged Administrative Costs, Affordable Care Act, Best Practice, CAQH, Compliance, CORE, ERA/EFT, healthcare payments, healthcare reform, payer-to-provider payments

Going Electronic? How to Get Your Providers on Board

In 2020, 26% of surveyed healthcare payers said that more than half of their provider networks still don’t accept ERA/EFT (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 can you

Tagged Administrative Costs, Best Practice, Compliance, ERA/EFT, healthcare payments, healthcare reform, payer-to-provider payments, payers, reconciliation, remittance

Enhance the Provider Experience: Deliver Payment Assurance

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

Tagged Administrative Costs, Best Practice, Claims, Clearinghouse, Eligibility, ERA/EFT, healthcare payments, patient estimation, patient payments, patient responsibility, payer-to-provider payments, payers, remittance

How to Keep Your Provider Network Happy

For a healthcare payer’s provider network, the process to get paid has always been a challenge. The steps providers take each day, from verifying eligibility and submitting claims, to receiving and reconciling payments, are filled with manual work, paper, errors and delays. As a result, the fragmented, time-consuming and often stressful process to collect payments is adding a lot of cost pressure on providers.

New healthcare reform mandates also put pressure on providers to find ways to get paid more efficiently.

Tagged Administrative Costs, Affordable Care Act, Best Practice, Eligibility, ERA/EFT, healthcare payments, healthcare reform, increase collections, patient estimation, payer-to-provider payments, payers, payment assurance, payment strategies, private cloud, providers, reconciliation, remittance

What the New EFT Regulations Mean for You

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

Tagged Administrative Costs, Affordable Care Act, Best Practice, CAQH, Compliance, CORE, ERA/EFT, healthcare payments, healthcare reform, Medical Loss Ratio, patient responsibility, payer-to-provider payments, payers, providers, reconciliation, remittance, reporting

Why the New EFT Rule Could Have Been Better

Guest Blogger: Bill Marvin, President & CEO, InstaMed

Recently, the Centers for Medicare & Medicaid Services (CMS) announced a final rule adopting electronic funds transfer (EFT) standards, which are part of the ACA provisions that call for improved administrative efficiency. While this rule is just one piece of the ACA operating rules, the adoption of the rule for EFT standards lays a positive foundation for the future of both EFT and ERA (electronic remittance advice). However, a couple of serious flaws

Tagged Administrative Costs, Affordable Care Act, Best Practice, ERA/EFT, healthcare reform, payer-to-provider payments, payers, providers, reconciliation, remittance

Achieving Success with Integrated Healthcare Payments

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

On an

Tagged Administrative Costs, Claim Status, Claims, Clearinghouse, ERA/EFT, healthcare payments, increase collections, patient payments, payment card, practice management system, private cloud, reconciliation, reporting

Blog Post Topic: ERA/EFT