Healthcare Providers and the Changing Dynamics of Payments and Information

Posted by Mike Fontana on 21 Dec 2015

consumerism, technology, and healthcareConsumerism, regulations, and an aging general population are all affecting how healthcare providers practice and how much they get paid. A major area of contention is the way providers receive payments from both institutional organizations such as governments and increasingly, their consumer-patients.  Taken altogether, there is a lot a provider must consider as institutional and individual market variables change. As providers face increasing administrative management needs, let us briefly examine some things regarding payments and their potential effects.

Market forces, changing payment models, and the Internet have been driving providers to collect more of their payments electronically from their patients.  As value-based payments push into the norm and replace fee-for-service models, ensuring payments are correct, timely, and properly distributed among organizations and networks is becoming even more consequential. These modern compensation models require providers to deliver comprehensive service for a fixed sum amount, marking a shift from payment for individual services. This fixed sum is often split between multiple providers, and funds may derive from multiple sources. With so many variables at play, the lack of a centralized payment processing system to help coordinate everything could put healthcare providers at a significant administrative disadvantage. Outdated bill presentment and payment systems could even put providers at a competitive disadvantage, as many healthcare consumers now prefer digital methods.

Healthcare providers must prepare for the accounting, payment collection, information collection, and consumer engagement necessary to stay connected and competitive. Proper preparation and organization will ensure providers get paid for their services, create efficiencies that allow for better service, and provide the individual experience healthcare consumers seek.

To increase efficiency, paper EOBs can be turned into electronic copy. Data files can also be captured, analyzed, and uploaded to the respective PAS/PMS. Healthcare providers will have to properly account for, analyze and disperse any ERA information internally and to their institutional partners. Electronic payments can be re-associated to claims with the proper ACH CCD+ and vCard process. Providers can work with payers who have the infrastructure in place to receive files and process multi-payment type provider requests, whether developed internally or acquired through partnerships with strong vendors (the more likely scenario.) This would give providers the option to make accounts receivable payments decisions based on cash flow and operational resource needs at any specific point in time.

In a previous blog, I discussed statistics illustrating the growth of consumer-directed healthcare, and the patient responsibility that develops as a result of it. These new pressures from both payers and changes in consumer payments will force healthcare organizations to reevaluate how they work their revenue cycles. The HIMSS organization has organized a new workgroup regarding this very subject: how new forces will make it imperative for healthcare institutions to institute a new RCM process in order to keep costs in check and meet the needs of the new consumer. This includes further development of a data hub, as well as increased and improved integration between the clinical, administrative, and financial aspects of healthcare organizations.

In my opinion, this will also include further development, advancement, and use of technology—whether it be portal and API integration, telemedicine, specific applications designed to give providers the ability to work more efficiently within the confines of their structures, or mobile applications that allow consumers to access the healthcare system when, where, and how they would like.

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Mike Fontana Healthcare Industry Executive Mike has served in various roles for Consumer Directed Health Care Technology companies. His background also includes Management, Market Development, Consultant, and other roles for healthcare providers, financial institutions, and payers. Mike holds an MBA in Finance from Pace University in New York.

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