Payer Security Focus: Preventing Ransomware in Healthcare

Ransomware is a type of malicious cyberattack that has grown in notoriety and frequency in recent years. Like kidnapping, ransomware works by taking something valuable to an organization – such as data files – and holding it hostage until a ransom is paid.

Ransomware infiltrates an organization’s system by infecting someone’s computer with a virus, which is likely accomplished by tricking that person into clicking a link or downloading a file in a phishing email. These emails are disguised as a

Tagged payers, ransomware, Security and compliance

Payers, What Does Age Have to Do With Healthcare Payments?

Healthcare spending grew to $3.48 trillion in 2019 and is expected to reach $6.2 trillion by 2028 (Centers for Medicare & Medicaid Services). Much of this growth has been and continues to be spurred by increasing consumer responsibility for both healthcare services and health plan premiums.

Consumer payment responsibility for healthcare services has increased. This is partly due to high deductible health plans, which have become increasingly popular with employer groups and in the individual market. In 2010, 10 million consumers

Tagged healthcare payments, payers

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

Tagged healthcare payments, patient payments, payer-to-provider payments, payers

Latest Trends and Practices for Payers to Prepare for the Future

A previous post detailed the latest trends in healthcare payments impacting how providers do business and best practices for providers to meet those challenges. However, the latest trends in healthcare payments present unique challenges for payers, which they must adequately prepare for – or risk consumer dissatisfaction and lost revenue.

Data from the 2013 Trends in Healthcare Payments Annual Report demonstrates that healthcare payments industry is evolving and outlines how payers can manage these changes. In particular, healthcare consumerism and provider

Tagged Best Practice, CAQH, Consumerism, ERA/EFT, healthcare payments, payers

ERA/EFT Mandate: Impacts to Providers

In 2014, all payers will be 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. Providers may be wondering how this mandate will affect payer payments and what you must do to be compliant.

Under the mandate, providers have no obligation to accept ERA/EFT from payers. However, the mandate enables providers to improve efficiency and reduce administrative costs. Read on to learn more about how

Tagged Administrative Costs, Best Practice, CAQH, Compliance, ERA/EFT, payers, providers

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 (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 can you

Tagged Administrative Costs, Best Practice, Compliance, ERA/EFT, healthcare payments, healthcare reform, payer-to-provider payments, payers, reconciliation, remittance

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

Tagged Administrative Costs, Best Practice, Claims, Clearinghouse, Eligibility, ERA/EFT, healthcare payments, patient estimation, patient payments, patient responsibility, payer-to-provider payments, payers, remittance

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.

Tagged Administrative Costs, Affordable Care Act, Best Practice, Eligibility, ERA/EFT, healthcare payments, healthcare reform, increase collections, patient estimation, payer-to-provider payments, payers, payment assurance, payment strategies, private cloud, providers, reconciliation, remittance

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

Tagged Administrative Costs, Affordable Care Act, Best Practice, CAQH, Compliance, CORE, ERA/EFT, healthcare payments, healthcare reform, Medical Loss Ratio, patient responsibility, payer-to-provider payments, payers, providers, reconciliation, remittance, reporting

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

Tagged Administrative Costs, Affordable Care Act, Best Practice, ERA/EFT, healthcare reform, payer-to-provider payments, payers, providers, reconciliation, remittance

Blog Post Topic: payers