InstaMed Blog Archives

Virtual Payments: Not Just a Phase in Healthcare

Virtual payments are an emerging payment method for payers to send payments to providers using the card networks. These payments are more commonly known as “virtual cards,” since the recipient can process them just like a credit card.

Thirty-seven percent of providers indicated that they received virtual payments from some payers.

This statistic accurately demonstrates what many providers are currently experiencing: Virtual payments are increasingly leveraged by payers as an alternative to mailing paper checks. While many believe that virtual payments are

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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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Upcoming Operating Rules: Why Providers Should Care

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

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Going Electronic? How to Get Your Providers on Board

Last year, the majority of surveyed healthcare payers said that less than half of their provider networks did not accept ERA or EFT (read more: 2011 Trends in Healthcare Payments Annual Report).  Of the providers who did not accept ERA or EFT during the time of this survey, nearly half said the reason was that they simply preferred paper.

However, according to the HHS interim final rule on EFT standards, payers will need to adopt ERA/EFT by January 1, 2014; and,

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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

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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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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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New Reform Mandates: What Can Providers and Payers Expect

Now that we are certain about new regulatory mandates and the direction of healthcare in the U.S., the industry can refocus its efforts on preparing for the road ahead.  Here’s a look at what we can expect in healthcare payments in the next decade:

More Coverage = More Patient Payments

Approximately 30 million uninsured Americans will begin to receive healthcare coverage in 2014. While the enrollment process will take multiple years, we believe that the majority of this group will receive coverage

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