Five Major Forces Impacting Payer Performance

October 18, 2016 by Antonio Arias, MBA, CHBME

Topics: Meaningful Use Stage 2, Practice Management, Medical Billing Company

At NCG Medical Billing, we’re committed to helping our customers achieve high first-pass resolve rates and prompt payments on their claims. But we’re far from the only entity involved in the revenue cycle.

Payers can be highly problematic to work with for a variety of reasons, ranging from poor customer service to long payment cycles to stringent claim requirements or otherwise. And in 2016, payers are facing more challenges than ever thanks to shifting reimbursement models, mergers, and criticism from an industry that often sees them as the enemy.

Amid today’s rapidly evolving healthcare system (and the changing nature of medical billing as a result), this year’s PayerView report, compiled annually by AthenaHealth, found five particularly significant dynamics now impacting payers’ overall performance.

Payer Mix: As the U.S. population continues to age, more individual patients are utilizing Medicare in addition to private coverage. Adding to the mix is Medicaid, which has seen increased enrollment since the passage and implementation of the Affordable Care Act. With multiple insurers in the mix for every claim transaction, the odds of incurring errors goes up.

Payment Transformation Acceleration: Following in the footsteps of Medicare’s Shared Savings ACO program and other cost-sharing initiatives, insurers are facing pressure to move away from the fee-for-service model – and fast. While many see the changes as overdue, they represent a massive shift from insurers’ traditional way of doing things, at times adding new kinks to the reimbursement process.

Payer Consolidation: Mergers are forcing payers to partner up, whether they like it or not, in areas like technology, data sharing, and more. And with more consolidation across the market expected in 2017, practices could see payment delays as a result of major changes.

Patients Slow to Pay: This one likely won’t surprise any providers. As high-deductible plans continue to make patients ever-more responsible for a greater portion of their care costs, individuals are paying at a slower pace than ever – and the unwelcome trend will likely stick around for years to come.

Automation Slow to Evolve: Even though the healthcare industry has stronger technology tools than ever, payers remain more in the ‘dark ages’ than they should be. Despite advances, many manual processes pervade payer operations – especially when it comes to prior authorization, credentialing, and other time-consuming efforts.

Making your medical billing function operate as seamlessly as possible amid these shifting forces may take the help of an expert partner. To find out how a trusted medical billing service like NCG Medical can help your bottom line, contact us.

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