Presentation on theme: "Healthcare Payment & Remittance Medical Banking - Best Practices"— Presentation transcript:
1 Healthcare Payment & Remittance Medical Banking - Best Practices Art Conklin, Director of FirstProxy andElectronic Payment Services
2 Electronic Healthcare Payment Session Objectives Overview of medical banking models in the healthcare payment and remittance marketplaceExploring best practices with an eye on:ROIInter-operabilityAuditingReconciliationContext – emerging marketplace
3 The Electronic Healthcare Payment Critical Success Factors Connectivity is the keyTransaction flow controlsOperational efficiencies, savings and profitable revenues.Reconcile billed to paid.Reconcile financial to administrative, the ERA to the EFT.Efficient Customer Support
4 The Electronic Healthcare Payment Managing the Critical Control Points Fitting the pieces togetherTransaction standardsSystematic reconciliationOn-line ERA management toolsConsistent operational practices, such as enrollmentLinking ERA and EFTMeaningful adjudication codesPurging the paper and handling
5 Healthcare Electronic Payment Models Standard healthcare claim and paymentProvider to Plan to ProviderCombining the administrative (ERA) and financial payment transactions (EFT)Outsourcing payment componentsConsumer driven plans and healthcare fundsGreater member responsibility for selecting services & allocating payment.
6 Standard Electronic Healthcare Payment Cycle ProviderHealtcare serviceto patientPaymentERA/EFT ReconciliationClaims SubmissionClaim Payment Life CycleClearinghouseClearinghouseACHPaymentRemittance AdviceEFT/CheckPayerAdjudication
7 The Standard Electronic Healthcare Payment Model Clearinghouses process 835 from Payer to Provider’sPayer’s bank processes EFT to Provider’s bankSupport Vendor IntermediariesOn-line management & support tools.Building partnerships to provide quality, value add products & services.Priced to produce savings and profitable revenues.
8 Combining Administration and Financial Transactions FirstProxyUSPSHealthcare ProviderPrintand mailERAEFTProvider DatabaseReconciledProprietary, Internet-based registration process that relieves a payer from attempting to secure their providers’ banking informationAdvanced notice of direct deposit and electronic remittance advices via automated notificationEmbedded web link accesses the payment’s corresponding remittance adviceERAElectronic paymentPayer
9 EFT capability through ERA. ERA-EFT reconciliation. Combining the Electronic Healthcare Payment’s Administration and Financial TransactionsFirstProxyEFT capability through ERA.ERA-EFT reconciliation.Single management tool for both payment transactions.Consistent operational workflowEfficiencies multipliedFully outsourced payment functions
10 Final completion of Phase 1 of HIPAA Transactions Combining the Electronic Healthcare Payment’s Administration and Financial Transactions - ChallengesFirstProxyRealignment of traditional partnerships in managing healthcare payments.Slower than expected market acceptance to outsourcing payment function.Final completion of Phase 1 of HIPAA TransactionsRecognition of value equation
11 Electronic Payments in Consumer Driven Health Plans and Funds ProviderCard swipeHealthcare service to patientPaymentAuthorization / funds transferFund / plan eligibility – fund withdrawalEligibility / benefit verificationFund Payment Life CycleClearinghouseACHClearinghouseACHPaymentRemittance AdviceEFT/CheckFund / Plan AdministratorERA = Electronic Remittance Advice
12 Electronic Payments in Consumer Driven Health Plans and Funds Multi purpose benefit card is emerging to handle member payment responsibilities in consumer driven health plans and funds.Credit / Debit of accountsAdministrative transactions, e.g. eligibility / benefit verification.Fits into provider workflow.Newer technology for POS devices permits for larger data requirements.
13 Credit funds beyond debit accounts. Claim submission as component. Electronic Payments in Consumer Driven Health Plans and Funds Value Add OpportunitiesCredit funds beyond debit accounts.Claim submission as component.Integrated eligibility and benefit verification to determine who is responsible for what of the treatment costs.Advance payment for plan’s payment responsibility.
14 Electronic Healthcare Payment Summary Electronic payment with value-added services (i.e. Web management tool).ERA/EFT combination via strategic partnership.Multi-purpose benefit card support.Value add products & services where opportunities exist.Priced according to value.
17 Healthcare Account Debit Flow POS TechnologyPayer Gateway data translator(eligibility/benefit verification –ANSI 270/271)edits connectivityPayer Gateway data translator(ANSI 835), ANSI edits connectivityEligibility / benefit planEnrollment / plan and fund set-upPayer banking interfacePlan Sponsor Gateway –data translator(ANSI 834), ANSI edits connectivityFunds transferPayer Gateway data translator(eligibility/benefit verification –ANSI 270/271)edits connectivityFinancial debtProvider bankBanking institution EFT transaction creation and routingProprietary, Internet-based registration process that relieves a payer from attempting to secure their providers’ banking informationAdvanced notice of direct deposit and electronic remittance advices via automated notificationEmbedded web link accesses the payment’s corresponding remittance adviceFundstransferPlan Sponsor Gateway –data translator(ANSI 834), ANSI edits connectivityPlan Sponsor FundProvider office POS (card swipe) deviceERA = Electronic Remittance Advice
18 SummaryProxyMed is the nation’s ONLY full suite of healthcare business solutions, offering beginning-to-end solutions.Transform the remittance advice and payment process from paper-based to electronic, resulting in:Automated healthcare claims payment and settlement processesImproved efficiencyReduced costsVerify eligibility and benefit information prior to administering healthcare services, resulting in:Improved administrative overheadBetter cash managementExpedited payment
19 ProxyMed Can Help You Achieve Success By… Enabling you to focus on core competenciesMaximizing profits through increased efficienciesExpediting payment processIncreasing productivity by reallocating resourcesFunctioning as your single source for all administrative transactionsEnabling you to focus on core competencies