Wednesday, November 17, 2010

Efficiency and Transparency Key Issues in Healthcare Payments Automation

By Lee Barrett of EHNAC

There are major industry shifts already underway that will change how the payment and document industry transacts business. With the complexity of changes taking place in relation to how ARRA, HITECH and HIPAA affect our industries, every payment processor and document manager would be wise to keep a finger on the pulse of the hot topics of the day and trends that provide indication of future directions for the industry.

One important change is the fact that providers and banks will be able to provide reconciled data streams so that any needed claim adjustments can be minimized and there can be a marrying of the remittance and electronic funds transfer. The benefit of this reconciliation is that manual intervention becomes minimal for inputting data into accounts payable applications, and there are few additional contractual adjustments required as compared to the large number needed today. This is, of course, all to the benefit of the provider organization and ultimately the patient or payer.

The second recent trend is, in fact, the revitalization of an old trend. With the ever-increasing cost of health insurance, organizations are seeking more economical solutions to meet the needs of their employees. As a result of this, the industry is seeing healthcare savings plans regaining traction at a significant rate. Health savings accounts or HSAs are most frequently used in conjunction with a benefit debit card, and give employees the benefit of being able to put pre-tax dollars toward deductible payment or coverage of other health related services. Given the complexities of HITECH, HIPAA and COBRA, organizations and financial institutions offering HSAs are required to keep track of changing regulations regarding excise taxes and concerns related to health and financial data security, privacy and confidentiality.

A third recent trend the industry is witnessing arises from the consumer demand for transparency in their healthcare experience, and the desire to have all healthcare payment and records available through a single portal. These “Wealth Care portals” provide for connections and efficient processing of all healthcare needs for a patient, allowing a patient to determine what they owe different providers, by tracking their invoices and payments through a single site. These portals would also give patients the ability to make better-informed decisions, make use of calculators and tools to determine costs and savings and track the status of claims made to their health insurance.

The electronic healthcare and payment-document processing worlds are changing rapidly, with exciting developments coming to light almost daily. To ensure that these trends truly benefit our own customers, it makes sense to stay abreast of the changes, and constantly analyze what the changes mean to our organizations as well as to our stakeholders.

Lee Barrett is executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC).

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