Inefficient processes have long been prevalent in healthcare, especially when it comes to payments. Over the last few years, steady increases in patient responsibility and federally-legislated regulations and incentive programs have led healthcare organizations to invest in software and technologies in an attempt to scale the growing healthcare economy. As a result, your organization may be using multiple systems for billing, payments, patient records and more.
What challenge does this present to my healthcare organization?
The challenge is that these systems are
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
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
The increase in self-pay patients and rising operational costs are driving healthcare providers to seek out tools and strategies to operate more efficiently and collect more from patients. Depending on your current processes to collect, there are various changes you can make that can have a significant impact on the amount collected and the time and costs spent to collect. Below are three common process issues that billing service Medical Management Corporation of America (MMCOA) faced with its providers, and
The term “administrative efficiency” has been popping up everywhere in the healthcare industry lately. Most provider organizations, from the solo-physician practice to the large health system, should know that they need to make strides to achieve administrative efficiency. However, how can you measure efficiency to tell if you’ve achieved it, or if your administration is still inefficient?
Faced with these questions, Judy Downing, the Billing Manager at Holly Springs Pediatrics, decided to quantify inefficiency in her practice by identifying her greatest
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
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
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
Over the past 10 years, one of the top administrative priorities for the healthcare industry has been the development of real-time adjudication (RTA) for healthcare claims. By 2005, the RTA effort had attracted a great deal of attention and effort across the industry. However, five years later, the results delivered have been underwhelming for both providers and payers.
The Core Problems
Although RTA makes sense from a high-level standpoint, the healthcare transaction process has nuances, both from a technology and business perspective.
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