8 Things ACOs Need to Know About Healthcare Payments

What Is an ACO?

An ACO (accountable care organization) is a healthcare organization made up of providers and payers who come together to give coordinated, patient-centered care. In the public sector, ACOs earn incentives for delivering high-quality care and reducing healthcare costs for Medicare and Medicaid patients. In the private sector, ACOs focus on achieving a high level of wellness and satisfaction for all patients.

What You Should Know About ACO Payments:

1. Increase focus on collecting from patients. As providers work to

Tagged ACO, EHNAC, ERA/EFT, healthcare payments, HIPAA, integrated healthcare payments, patient responsibility, payer-to-provider payments, payers, payment assurance, PCI-DSS, private cloud, providers, reconciliation, remittance

Steps to Payment Assurance: A New Model for Healthcare Providers

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

Tagged Claims, Consumerism, Eligibility, ERA/EFT, healthcare payments, increase collections, integrated healthcare payments, patient estimation, patient payments, patient responsibility, payers, payment assurance, payment strategies, providers

Electronic Payments: 4 Requirements to Integrate EFT with ERA

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

Tagged Affordable Care Act, CAQH, Compliance, CORE, EHNAC, ERA/EFT, healthcare payments, healthcare reform, HIPAA, ICD-10, Medical Loss Ratio, NACHA, payer-to-provider payments, payers, PCI, providers, remittance, SSAE 16

Payment Assurance Level One Certified: Austintown Pediatrics

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

Tagged Claims, Eligibility, ERA/EFT, healthcare payments, InstaMed Network, integrated healthcare payments, patient bad debt, patient payments, payment, reconciliation, remittance, vendor integration

Blog Post Topic: ERA/EFT

8 Things ACOs Need to Know About Healthcare Payments

Steps to Payment Assurance: A New Model for Healthcare Providers

Electronic Payments: 4 Requirements to Integrate EFT with ERA

Payment Assurance Level One Certified: Austintown Pediatrics