General economy prices have grown by 17.3% since the end of 2007 — healthcare prices have grown by 21.6%. This growth has left healthcare providers and payers searching for ways to lower costs without lowering the quality of care for patients. Many organizations are turning to technology and digitization to modernize systems and cut down on costs.
For payers, digitization of healthcare payments can help them not just cut costs but become operationally aligned with providers. Read on to find out how.
It’s no wonder overpayments are made when transactions don’t include full claims data. Without this vital information, staff is unable to double-check that payments align with claims before they send them out, leading to various human errors. Once mistakes are made, they take even longer to fix.
First, the provider must decide whether an overpayment was made. For this to happen, staff must reconcile the payer’s payment to electronic remittance files. Then, they must ensure that they have matched the correct documents. Once finalized, the provider must call or mail the payer to confirm that an overpayment has been made — which the payer’s staff must check as well.
If an overpayment is confirmed, the healthcare organization has an even longer process to complete. A team member must send a letter addressing the overpayment, wait up to 30 days to receive instructions regarding reimbursement, then complete the payer’s specific reimbursement process.
In a modern healthcare payment system, transactions include clear and detailed claims context. With this added context, payers find it easier to double-check their work and ensure they’re sending the correct payment amount.
Align With Providers
The healthcare industry is changing rapidly. Patients expect higher care quality — meaning providers and payers must search for new ways to appeal to them while mitigating rising costs.
To curb rising costs, providers and payers must work together toward a more efficient and effective system. This begins with healthcare payments. Success will come when payers and providers work together to fix the slow, expensive, and contextless system.
Typical transactions, like paper checks and automated clearing house (ACH) payments, move far too slowly, creating a backlog. This backlog causes difficulty when payers and providers need to reconcile payment issues.
Payers spend far too much to print and mail checks or are forced to pay fees to send money via ACH. ACH pricing models are inflexibly set by the bank and offer few options for flexible monthly or yearly payment schedules. On the other side, each invoice and paper check costs as much as $31 to process.
Finally, the lack of claims data attached to payments causes issues for both payers and providers. Because only patient and incident names are included, provider staff is forced to spend time reconciling payments to electronic remittance files. Then, the staff has to investigate why payments were not paid in full or why an overpayment occurred, then resubmit payment requests. In turn, payers spend time reviewing resubmissions and sending more payments.
Pioneer Digital Transformation in Healthcare
Digitalization within the healthcare industry comes with a wealth of benefits to providers, payers, and patients. Healthcare organizations can analyze all data across channels and systems, using that information to streamline operations, provide personalized care options, or evaluate new care formats like telemedicine and outpatient care.
Modernizing your healthcare payments through digitization is a big step. Expedited, inexpensive, and transparent payments lead to lower costs for all parties — including patients.
When thinking through how modernized payments will benefit your organization, make sure you choose a platform that:
- Processes payments within 24 hours while providing extensive tracking abilities
- Offers a flexible pricing system that allows clients to determine whether a monthly or low-cost per-payment basis works for them
- Shows exactly what your payment is for, including line items, physician details, and percent paid
- Supports government to business, patient to business, and business to business transactions
- Has open APIs and a dedicated development team so integrating the system into your existing technology is simple
Considering such clear advantages that benefit payers, providers, and patients, modernizing healthcare payment systems is a logical first step toward digitization for any payer.
Are you interested in becoming a pioneer of digital transformation? Contact us to learn about what it looks like to be a part of our pilot program.