Steps to Payment Assurance: A New Model for Healthcare Providers

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

Tagged Claims, Consumerism, Eligibility, ERA/EFT, healthcare payments, increase collections, integrated healthcare payments, patient estimation, patient payments, patient responsibility, payers, payment assurance, payment strategies, providers

Real-Time Adjudication – Is This the Silver Bullet?

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.

Tagged Claims, healthcare payments, increase collections, integrated healthcare payments, payers, payment assurance, providers

Electronic Payments: 4 Requirements to Integrate EFT with ERA

Healthcare reform is a major factor driving change in payer-to-provider payments, including the medical loss ratio (MLR) requirement in PPACA. To reduce administrative costs and meet the MLR mandate, payers are implementing more efficient payment delivery methods. One such method is the offering of ERA/EFT, which combines both the payment and the healthcare payment information to enable provider funding, posting and reconciliation. While many payers have been sending providers ERAs (electronic remittance advice) for years, it’s time for payers to

Tagged Affordable Care Act, CAQH, Compliance, CORE, EHNAC, ERA/EFT, healthcare payments, healthcare reform, HIPAA, ICD-10, Medical Loss Ratio, NACHA, payer-to-provider payments, payers, PCI, providers, remittance, SSAE 16

5 Risks for Payers in the Healthcare Payments Landscape

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The lack of payment assurance in healthcare poses a problem for the industry, during a time of rising consumerism and healthcare reform. Here are the top five risks of the lack of payment assurance to the healthcare payer.

1. Provider Network Satisfaction/Discounts

Providers will become increasingly dissatisfied with the arrangements that they have made with payers. Healthcare reform like MLR adds administrative cost pressures that will

Tagged Affordable Care Act, Consumerism, healthcare payments, healthcare reform, Medical Loss Ratio, payers, payment assurance, providers

Blog Post Topic: payers

Steps to Payment Assurance: A New Model for Healthcare Providers

Real-Time Adjudication – Is This the Silver Bullet?

Electronic Payments: 4 Requirements to Integrate EFT with ERA

5 Risks for Payers in the Healthcare Payments Landscape