Many healthcare providers are concerned about the impact to their businesses that will result under PPACA. Much of this concern is due to the additional 20 to 30 million uninsured Americans that will begin to receive new healthcare coverage in 2014. With more patients eligible to receive healthcare services, and hundreds of millions of patient payments transactions being added to the U.S. healthcare system, the difficulties providers face with patient collections is becoming a high priority issue.
Shifting the focus to
The rise of consumerism in healthcare is driving providers to evaluate their tactics to collect healthcare payments. While providers previously relied almost exclusively on payer payments for their revenue, patient responsibility is increasing as a portion of provider revenue. In order to collect more from patients and reduce administrative costs, providers need to offer more convenient, consumer-friendly payment options, such as online patient payments.
According to the 2011 Trends in Healthcare Payments Annual Report, online patient payments have tripled since 2009.
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.
In the healthcare industry, the clearinghouse you work with has a huge impact on your business. The more efficiently your clearinghouse processes and returns your information, the faster you will get paid, and the more payments you will collect.
To gain insight into what providers need from a clearinghouse, we interviewed Kevin Milam, owner of The Billing Center, which does billing, consulting and accrediting for providers across several states. We came up with five essential qualities to look for when researching
We’ve covered the challenges healthcare payers face as rising consumerism and healthcare reform impact the industry. Now, let’s look at the healthcare provider’s perspective. Here are the top four risks to healthcare providers as the industry evolves:
4. Rising Administrative Costs
Providers will face increasing administrative costs to maintain the same level of revenue. Provider front offices will need to spend more time with patients to work through their payment responsibility and helping them understand their payment options. Provider back offices will
We’ve discussed the lack of payment assurance in healthcare and why this poses a problem for the industry today, during a time of rising consumerism and new 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 force providers to re-assess their network relationships — which