In 2014, all payers were 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. Though the mandate went into effect in January 2014, the industry has been slow to adopt the electronic alternative to paper checks. Many organizations send a high dollar volume through ERA/EFT, but it’s the low percentage of transactions sent through ERA/EFT that keeps print and mail costs high. The costs
In 2017, U.S. healthcare spending reached nearly $3.5 trillion, or $10,348 per consumer, at a projected growth rate of 4.6 percent. Healthcare spending has become nearly a fifth of the nation’s total Gross Domestic Product (Centers for Medicare & Medicaid Services). This steady growth and large size of the industry make it a major economic driver for the country.
Whether the industry can sustain this size and growth are questions that remain unanswered. The answers, and thereby the future of the
Every month, the Payer Security Focus breaks down a different topic in security and compliance with information relevant to payers and actionable steps to help build a more robust security and compliance program at their organizations. This month’s topic is anti-money laundering.
What Is Anti-Money Laundering (AML)?
Money laundering is the process of turning “dirty money” or the profits from a crime into legitimate money. This is primarily done through incorporating illegal funds into the financial system in such a way that
Every month, the Payer Security Focus will break down a different topic in security and compliance with information relevant to payers and actionable steps to help build a more robust security and compliance program at their organizations. This month’s topic is compliance versus security.
What is the Difference Between Compliance and Security?
To understand the importance of compliance and security in healthcare payments, first let’s clarify the difference between the terms compliance and security. Both are important to healthcare payments, but these
Every month, the Payer Security Focus will break down a different topic in security and compliance with information relevant to payers and actionable steps to help build a more robust security and compliance program at their organizations. This month’s topic is PCI DSS.
What is PCI?
PCI DSS stands for Payment Card Industry Data Security Standards and applies to all entities involved in payment card processing, including merchants, processors, financial institutions and service providers. It also applies to all other entities that
To stay competitive, payers are developing more comprehensive benefits packages that include health, dental, wellness and vision plans for more attractive offerings. However, billing for these different plans means coordinating disparate systems and varied employer group billing preferences.
To bill employer groups, payers send out multiple paper statements to collect payments across all of the plans and members – each managed separately by the employer group. For the individual market, members may receive separate bills for each plan with different payment
The concept of health insurance in the U.S. first started during the Great Depression when Baylor University Hospital in Texas offered teachers the benefit of prepaid hospital expenses for a $5 per month fee. However, it wasn’t until World War II that health insurance became a widespread benefit offered by employers. WWII forced employers to rely on “fringe benefits” like health insurance to attract more workers to meet the higher demand for resources to help fight the war, while food
Consumer engagement is top of mind for many in the healthcare industry. This is especially true for payers who are challenged to connect with members in the individual markets. (Read more on consumer engagement here.)
However, employer groups still make up a large portion of the covered lives for most payers. To stay competitive, payers increasingly are developing comprehensive benefits packages that include health, dental, wellness and vision plans for more attractive offerings. Yet, the billing process for these plan premiums
When you think of a hacker, what comes to mind? Do you picture someone dressed as a burglar sitting at a desktop computer in a dark room? If you do, then it’s time to reconsider that idea. For this month’s security focus, we’re going to talk about social engineering and how it turns the hacker stereotype on its head.
Social engineering is a non-technical method of human intrusion that relies on human interaction and often involves tricking people into divulging confidential
Healthcare is one of the last industries where the majority of information is primarily transmitted via paper, including: EOPs, EOBs, mailed paper statements, paper check payments, etc. Overall, the ability to support these paper-based transactions requires manual processes that cost payers significant resources – consider that 16 percent of total healthcare spending is on administrative costs. Take a look at our infographic below for more on the true cost of paper in the industry.