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InstaMed Tips & Tricks

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July Tips & Tricks

EDI Enrollment

With InstaMed

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Clearinghouses are Becoming Obsolete

Recent healthcare news announcements indicate that another major clearinghouse has disappeared. This is a trend that started a few years ago and will continue. In fact, of the top clearinghouses from five years ago, only a portion are still in business, some of which are in the process of exiting the business through strategic sales by their equity investors.

Why are clearinghouses disappearing?

Technology Barriers
One of the major factors contributing to the disappearance of clearinghouses is the fact that most clearinghouses are

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3 Models to Achieve Compliance with Upcoming Mandates

Recently, we posted a list of five things that payers can do now to prepare for upcoming reform mandates (click here to read the post). This post emphasizes the importance of collaborating with other organizations like clearinghouses, trading partners and vendors, in order to achieve compliance with the mandated CAQH CORE Operating Rules. These relationships are crucial regardless of the approach payers take to achieve compliance.

Below is an outline of the three main models payers can use to meet the

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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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4 Signs That You Are Billing Inefficiently

The term “administrative efficiency” has been popping up everywhere in the healthcare industry lately.  Most provider organizations, from the solo-physician practice to the large health system, should know that they need to make strides to achieve administrative efficiency.  However, how can you measure efficiency to tell if you’ve achieved it, or if your administration is still inefficient?

Faced with these questions, Judy Downing, the Billing Manager at Holly Springs Pediatrics, decided to quantify inefficiency in her practice by identifying her greatest

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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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8 Things ACOs Need to Know About Healthcare Payments

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

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