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InstaMed Blog Archives

Interoperability: Beyond the Clinical Side of Healthcare

Growing need for interoperability

Healthcare reform is driving a greater need for efficiency, resulting in the formation of Accountable Care Organizations (ACOs) and provider consolidation.  As provider organizations using different systems work together, there is a much greater need to integrate heterogeneous environments to achieve system interoperability.  However, healthcare information is often not easily exchanged among providers because of paper-based processes or systems that are not compatible.  In fact, 71% of providers surveyed said the lack of system interoperability is a

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Latest Trends in the Healthcare Payments Industry

The U.S. healthcare payments market is growing and changing rapidly – in fact, it is estimated to have reached $2.7 trillion as a total of payer and patient payments (IDC Health Insights).  The fast evolving healthcare payments industry is impacting the way both payers and providers do business.

This week, the 2012 Trends in Healthcare Payments Annual Report was released to highlight the trends impacting the growing industry and the steps that many payers and providers have taken to accommodate for

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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

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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 (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

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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. 

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Hold the Phone! Tips on Reducing Call Center Volume

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

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Top 3 Misconceptions of Collecting from Patients

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

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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

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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

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Latest Trends in Healthcare Payments for Providers and Payers

The latest trends in the healthcare industry — the rise in consumerism, increase of costs and new regulatory mandates — are driving change in the healthcare payments process. As health insurance premiums continue to grow, employers are switching to lower cost, high-deductible plans, resulting in an overall decrease in payer payments and, consequently, an increase in patient payments. As a percentage of provider revenue, in 2009, payer payments represented 79% of the allowed amount, while patient payments represented 21%. In

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