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Healthcare Payment Processing: What You Need to Know

Healthcare Payment Processing: What You Need to Know

As competition in the healthcare industry continues to heat up, providers and billers must look to new options to provide seamless and flexible payment options to retain customers and attract new ones.

Providing a variety of convenient payment options is more important than ever

Patients are frustrated by their healthcare payment options. While they understand the importance of paying their bills, they also want to be able to pay them in a way that is convenient. Many patients would rather pay their bills by credit card rather than cash or check, but they do not always have this option.

Patients have adopted a consumer mindset. From their perspective healthcare transactions should be no different from other transactions. They are more reluctant than ever to put a check in the mail and cross their fingers. In a world of easy online payments and tap-to-pay convenience, healthcare providers need to recognize that the patient financial experience is just as important as the patient care experience.

Most importantly, providing these payment options are not just about giving patients more convenience, but about the bottom line. Embracing new functionality like card-on-file recurring billing and SMS text message payment reminders saves your staff time and increases payment rates.

“We sent out the first SMS payment requests last week, and within several hours had generated 9 payments for a total of over $2,400 back from the patients! The provider is thrilled.”

As the healthcare industry continues to become more competitive, it becomes more critical than ever to create efficiencies wherever possible.

Patient payment data security must be a top priority

In 2016, healthcare organizations suffered a record-breaking number of data breaches. These breaches are not just affecting the health of patients and the financial bottom line of providers – they are also affecting their reputation.

A survey conducted by Ponemon Institute in 2017 revealed that healthcare organizations lost an average of $2.1 million per breach and nearly a third reported losing between $1 million and $10 million per breach. In addition to these costs, there are also significant reputational consequences for healthcare organizations that suffer a data breach. More than half (52%) said they would avoid using a provider following a data breach.

Consumers are concerned about safeguarding their medical information when paying bills; 47% have significant concerns regarding the security of making payments for both medical bills and health plan premiums. They want to take advantage of the consumer protection guarantees that their credit card company offers and a PCI compliant payment processing like EZClaimPay.

Finding the right payment processing partner

Healthcare is more complex than many other industries — a tangle of relationships between patients, healthcare providers, insurers, and unique regulatory requirements such as HIPAA. In this context, there are many providers find that their payment and billing systems do not work well together. Because of these challenges, medical billers and healthcare providers stand to benefit by working closely with their payment processors.

EZClaim set out to build a payment processor from the ground up that addresses these concerns. EZClaimPay helps billers and providers save time and money with functionality like card-on-file recurring billing, ability to offset processing costs with the platform fee functionality, and automatic reconciliation. Plus, increase payment rates with text message reminders and convenient payment portal. Most importantly, because we serve healthcare providers exclusively, we have ensured compliant, industry standard security including PCI compliance.

Streamlining and optimizing payment processing expedites the patient payment process while increasing back-office efficiencies. Healthcare providers that offer seamless, secure, and flexible billing and payment options will retain more customers and continue to attract new ones.


EZClaim is a leading medical billing, scheduling, and payment software provider that combines a best-in-class product with exceptional service and support. For more information, schedule a consultation today, email our experts, or call at 877.650.0904.

Avoiding Common Revenue Cycle Management Mistakes

Avoiding Common Revenue Cycle Management Mistakes

The revenue cycle is a crucial component of a medical practice. Revenue Cycle Management (RCM) is the process of managing patient accounts, interacting with payers, processing claims, and collecting payments related to health care services. As the industry becomes more competitive and physicians are expected to perform more administrative tasks on their own, RCM has become even more important for healthcare providers today than ever before. Unfortunately, many practices still struggle with managing their RCM processes in an efficient manner that allows them to focus on what matters most: patient care. Below is a list of common mistakes made by healthcare providers when it comes to RCM.

Below is an overview of the seven key components of RCM and ways to avoid some of the most common mistakes.

Insurance Verification and Authorization

Insurance verification and authorization is a critical step in the revenue cycle process. If this step fails, all other steps must be repeated. This can result in delays, rework, denials of claims and even patient non-compliance.

  • Verify that the patient is covered by their insurance plan and will not be responsible for additional costs related to their treatment or procedure (co-pay and deductibles).
  • Verify that your provider is in network for each specific procedure with their chosen health plan/policy before completing any work on behalf of the patient.
  • Ensure that all documentation supports your claim(s), including diagnosis codes and clinical notes from EMRs or doctors’ offices detailing what was performed during each visit. These details should align with those found on physical charts signed by both patients and providers alike.
  • Verify eligibility rules as defined by health plans: has a deductible been met? Is there a copay amount due before benefits kick in? In some cases it may be necessary to contact members directly via phone or email asking them these questions so they know exactly how much they owe out-of-pocket. Our partner TriZetto Provider Solutions offers integrated eligibility verification. Automating this due diligence on the front end ensures that you are not left with the cost of having a biller redo this work, or worse, writing of claims.

Patient Registration and Copay Collection

Patient registration and copay collection are important first steps to ensure that your revenue cycle is functioning properly. Patient service, claims submission, remittance processing, and back-end patient collections are all vital components of the revenue cycle management process.

Without these steps in place, you will not be able to complete the full revenue cycle management process.

Service Coding and Charges

The service coding process identifies the type of service or procedure that was performed by your staff. Accurately documenting and coding charges allow you to:

  • Assign appropriate codes for reimbursements from government programs, insurance companies and self-pay patients.
  • Determine the level of reimbursement for each code
  • Avoid fraud and abuse

Billing and Collections

It is critical to collect payments on time, in full and accurately. If you do so consistently, it will be easier to predict future cash flow needs and improve your ability to manage the revenue cycle.

Timely billing is critical because it allows the practice to collect their fees before they become delinquent. Delinquent accounts must be reported to credit agencies which can negatively impact a patient’s ability and willingness to pay for other services at your facility in the future. Late fees should also be considered for patients who are more than 60 days late paying their bill – this can help generate additional revenue by encouraging prompt payment from patients who may otherwise have ignored their bills altogether.

Accuracy is key when collecting payments because inaccurate claims may result in denied reimbursement by Medicare or third-party payers’ due out-of-pocket expenses for patients who were mistakenly overcharged by providers.

Consistency means that providers need regular updates on where each account stands within its cycle; this helps ensure that both patient satisfaction levels remain high and that everyone receives timely access. Efficiency refers not only to how quickly accounts move through management but also how quickly they get paid so providers know exactly how much money they’ll have coming in each month before making subsequent budgeting decisions.

EZClaim provides great tools to help ensure your collections are timely, accurate, and consistent. EZClaim allows you to keep a credit card on file. With approval to charge up to a specified amount, you can make it convenient for your patients and ensure payments are timelier than ever. EZClaimPay also offers email and SMS text message-based reminders, which have proven effective in increasing payment rates.

Denial Management

Denial management is the process of managing patient denials. Denials can be caused by a variety of reasons, including incorrect CPT codes, missing information, or provider errors. Therefore, it’s important to have ready-to-go processes for handling them and getting paid as soon as possible.

When you receive a denial from an insurance company, there are several things you should do immediately:

  • Double-check that all your claims are accurate and complete before submitting them for payment. If there is any ambiguity on the part of the patient or their healthcare provider, this will increase the likelihood that your claim will be denied due to lack of clarity.
  • Request that more specific details regarding the denial be provided. This allows better preparation when submitting future claims related to this patient’s care and ensures there aren’t additional denials for similar reasons.

The revenue cycle is a crucial component of any medical practice. It’s also one of the most challenging aspects of running a practice, especially in today’s increasingly complex environment. This article has highlighted some common mistakes that can be made when managing your revenue cycle and how to avoid them.

Achieving a Stronger Denial and Appeal Management Strategy

Achieving a Stronger Denial and Appeal Management Strategy

Waystar’s newest guide investigates the state of denials and appeals in today’s healthcare landscape and explores how today’s most successful providers are redefining the core components of their denial and appeal process to grow revenue, streamline workflows and revitalize their approach to the process.

Denial and appeal management today

Like many administrative tasks further burdened by the impacts of the COVID-19 pandemic, denial and appeal management workflows dependent on manual processes are experiencing new strains on accuracy and productivity.

Last year a survey investigated how billing and administrative tasks were impacted by COVID-19, with 37% of surveyed providers reporting an increase in workloads due to issues with coding and requirements. An assessment of the general industry outlook found claim denial rates are at an all-time high, with 33% of surveyed hospital execs reporting concerns they are entering a “denials danger zone,” where rates grow to 10% or more.

Estimates put the cost of reworking denials as high as 20% of rev cycle expenses because on average they cost 4x as much to process than the initial claim. With so much strain already present on providers’ resources, many are turning to automation to ease the burden.

How automation elevates the process

Once a provider has been notified of a denied claim, steps are taken to identify whether or not it can be appealed. Many of the errors that cause denials come down to administrative issues that took place at the start of the claim lifecycle.

A recent analysis found 86% of the denials processed between July 2019 and June 2020 were avoidable. Analysis indicated that many of those issues stemmed from front-end errors related to benefit information, coverage detail, and shortcoming related to missing or invalid claim data.

While there’s a wide mix of problems that could cause a denial, with different providers experiencing a diversity of challenges depending on their location and patient population, they all face a common hurdle: the burden of manual denial management and appeal procedures put on administrative staff.

Like many other administrative processes, providers for the most part rely on a mix of manual and electronic procedures to handle denial and appeal management. But the industry’s continued reliance on manual procedures is beginning to have a negative effect.

How providers are transforming their approach to denial + appeal management

Studies have found that it costs about $118 in reworking fees to appeal a denied claim. These costs are exacerbated by the industry’s overall reliance on manual processes—a systemic issue many recognize yet fail to capitalize on. Indeed, while many providers see the promise automation can deliver on, they still face a number of considerations before pushing forward with implementing an automated solution.

And automation is a hot topic for providers for a very good reason—studies have demonstrated the US healthcare system could save as much as $16.3B by automating old or outdated processes. When it comes to denial and appeal management, the benefits are far-reaching, from improvements to productivity and a reduced strain on resources to huge boosts to claim accuracy and revenue recovery.

What to look for in a denial + appeal management solution

Leading-class solutions offer a wide selection of tools to provide a comprehensive approach to denial and appeal management, using customized, exception-based workflows to streamline the entire process and overturn a sizable increase in denials.

The appeal toolset a solution offers should make it easier to coordinate and use the info and data necessary to automatically process appeals and recover cash that would otherwise create productivity issues or unnecessary fees.

The solution’s ability to prioritize appeals based on cash value automatically lets staff concentrate on tasks that actually demand their attention, supporting them with additional tools like automatically generated payer-specific appeal forms and robust analytics capabilities that allow you to track and measure progress and problem areas.

Keeping disruptions at a minimum is key when considering your solution as well, so consider its ability to work efficiently with your existing systems and look for a partner that can demonstrate a strong history of seamless integrations.

Wrapping it up: why denial + appeal management solutions matters

A recent Waystar survey found 76% of providers categorized denials as their biggest RCM challenge. And the wider picture of healthcare reflects an industry struggling to solve a long-standing problem with manual processes and few answers.

Implementing an automated denial and appeal management solution is quickly becoming the optimal path forward for most providers, even if many have apprehensions about committing to the switch. But as new innovations cut down on the resources and time needed to implement the tech, the time is quickly approaching where the switch will be easier, and more vital, than ever before.

Click here to find out how Waystar can help fully automate the process and help you recover more revenue while reducing the burden on staff.

Heading to AMBA in October?  Visit Waystar and EZClaim while you’re there!  Stay tuned for more event details.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

[ Contribution from the marketing team at Waystar ]

After Pandemic Impact on Outsourcing RCM

After Pandemic Impact on Outsourcing RCM

After Pandemic Impact and Outsourcing Revenue Cycle Management

The impact of the COVID-19 pandemic will be felt in every industry for many months to come. For medical providers, they are facing some of the most challenging financial times they will or have known. Therefore, we understand that it is crucial for providers to re-access their business and look for ways to cut costs with minimal impact on their practice or their patients.

To compound the issues providers are facing, there has been a wave of changes in recent years with new coding and telemedicine requirements that are making it difficult for provider offices to remain independent. Add on the constant rise in the cost of living and expenses while insurance reimbursements continue to decrease, and the issues get worse and worse.

Many have decided that outsourcing to a complete revenue cycle management company could help alleviate some of the undue burdens, cut costs, and keep providers compliant with their coding and billing. Ultimately this allows providers to continue to focus on patient care, which is their goal. As providers, you understand that revenue cycle management is a crucial part of your physician’s office. If not managed properly, it could result in an office leaving thousands of dollars on the table in unclaimed revenue. Over the years, our free audit services have allowed providers to have a free, transparent, and unbiased assessment of how their accounts receivable department functions. We are always amazed at how many providers do their billing in-house, and sometimes even when they outsource,  are not aware of how much money they have sitting in their accounts receivables.  Getting this knowledge is the first step to increasing revenue and efficiency.

In-house medical billers and third-party outsourced revenue cycle management companies should be giving provider offices monthly aging reports to assess their financial forecast. Each accounts receivable bucket over 60 days should hover at approximately 1 0% or less of the entire revenue balance. If account receivable buckets are higher than 10%, providers may be leaving money on the table, and the account may not be getting worked as providers think they are. In efforts to avoid unpaid claims and a spike in accounts receivable, outsourcing your revenue cycle management to a third-party medical billing company, such as BC Medical Billing, could help providers in countless ways. Many practices recognize that keeping their revenue cycle management optimized is key in delivering regular practice operations; however, they are not always sure how to achieve that. Outsourcing may be the solution!

Outsourcing alleviates the practice from managing a new medical billing employee, paying a salary and benefits, completing training and onboarding protocols, and managing the lost time from a learning curve. Many providers feel that it is not a wise use of the back office executive personnel’s time to worry about finding coders in-house and then wondering if the charges are captured and billed correctly. Instead, the business office should be focusing on how to grow the providers and the physician practice.

Our free audits will help you determine if you have found the right solution for you. If not, we are always there to assist and always increase the provider’s revenue.


ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

[ Contribution from the marketing team at BC Medical Billing ]

Pandemic Impact and Outsourcing Revenue Cycle Management

Pandemic Impact and Outsourcing Revenue Cycle Management

The impact of the COVID-19 pandemic will be felt in every industry for many months to come. For medical providers, they are facing some of the most challenging financial times they will ever know. Therefore, we understand that is it crucial for providers to re-assess their business and look for ways to cut costs with minimal impact on their practice of their patients.

To compound the issues providers are facing, there has been a wave of changes in recent years with new coding and telemedicine requirements that are making it difficult for provider offices to remain independent. Add on the constant rise in the cost of living while insurance reimbursements continue to decrease, and the issues get worse and worse.

Many have decided that outsourcing to a complete revenue cycle management company could:

    • help alleviate some of the undue burdens
    • cut costs
    • keep providers compliant with their coding and billing

Ultimately, this allows providers to continue to focus on patient care which is their goal. As providers, you understand that revenue cycle management is a crucial part of your physician’s office. If not managed properly, it could result in an office leaving thousands of dollars on the table in unclaimed revenue. Over the years, our free audit services have allowed providers to have a free, transparent, and unbiased assessment of how their accounts receivable department functions. We are always amazed at how many providers do their billing in-house, and sometimes even when they outsource, are not aware of how much money they have sitting in their accounts receivables. Getting this knowledge is the first step to increasing revenue and efficiency.

In-house medical billers and third-party outsourced revenue cycle management companies should be giving provider offices monthly aging reports to assess their financial forecast. Each accounts receivable buckets over 60 days should hover at approximately 10% or less of the entire revenue balance. If account receivable buckets are higher than 10%, providers may be leaving money on the table, and the account may not be getting worked as providers think they are. In an effort to avoid unpaid claims and a spike in accounts receivable, outsourcing your revenue cycle management to a third-party medical billing company, such as BC Medical Billing, could help providers in countless ways. Many practices recognize that keeping their revenue cycle management optimized is key in delivering regular practice operations; however, they are not always sure how to achieve that. Outsourcing may be the solution!

Outsourcing alleviates the practice from managing a new medical billing employee, paying a salary and benefits, completing training, and onboarding protocols, and managing the lost time from a learning curve. Many providers feel that it is not a wise use of the back office executive personnel’s time to worry about finding coders in-house and then wondering if the charges are captures and billed correctly. Instead, the business office should be focusing on how to grow the providers and the physician practice.

Our free audits will help you determine if you have found the right solution for you. If not, we are always there to assist and increase the provider’s revenue.