The evolving role of payments in healthcare has been in the news lately, but most of the news has revolved around the growing financial responsibility of patients in high deductible health plans (HDHPs). The ways that providers accept and process patient payments has a huge impact on the overall patient healthcare experience. Less discussed are payments that providers receive from insurance plans for covered services. Despite the increase in patient responsibility for healthcare costs, providers still receive the bulk of their payments from insurers. Like every other industry sector that deals with B2B payments, healthcare has proven to be no exception when it comes to challenge of making B2B payments more efficient.
As consolidation grows in the provider space, companies are focused on managing the “revenue cycle,” or making sure that both outgoing invoices and incoming payments are processed quickly and efficiently to optimize cash flow and reduce costs. The challenge with healthcare insurer payments, like all B2B payments, is that invoices are adjusted by the payor according to contract rules, making it difficult for the provider to reconcile what was paid to what was billed. Insurer payments often include multiple patients, and payments must be applied to patient accounts properly so that patients can be billed for any balance still outstanding.
Fintech companies like Zelis are focused on improving the B2B payment environment for healthcare providers.
According to Alasdair Catton-Chastain, Senior Manager, Provider Experience at Zelis, “The remittance comes back to the cash posting team, which is typically a different business unit to the claims submission team. This is typical for a lot of offices once the provider gets over a certain size, but there is no communication internally between patient access and point of care through claim submission. All of that is quite siloed in most provider organizations.”
Overview by Don Apgar, Director, Merchant Services Advisory Practice at Mercator Advisory Group