Hacking the Payment Problem of Disconnected Healthcare Systems [Infographic]

Collecting healthcare payments and going to the doctor during COVID-19 has become increasingly complex and disconnected. When it comes to healthcare, most Americans want price estimates upfront, but only half of these estimates are accurate. As high deductible health plans are growing in popularity, patients often experience higher out-of-pocket costs, confusion about payment responsibility, and an increase in unexpected medical bills.

Wasted spending in healthcare is a large problem, and 25% of wasted spending is related to time and money spent on collecting processing, posting, and recording payments. Payments are collected from insurance payers, consumers, and a mix of both, but all are processed at a different time in the payment cycle, contributing to money loss. Denied claims raise costs; the work required to resubmit claims can cost up to 18 times more than a claim correctly filed the first time. 

Common mistakes that cause denial include out-of-network providers, incorrect patient identification, prior authorization required, and services not covered. Mistakes can also occur when systems are not interoperable, arising from manual data transfer between systems and difficulty verifying insurance eligibility. 90% of denied claims are avoidable; eliminating rework of just 100 claims a month would save the average practice $37,000 a year and could save a hospital $149,000 a year. 

Connected payments pose a simple solution for payment issues in healthcare. Contactless check-in and payments allow patients to complete digital registration for documents including COVID-19 screening questions, consent forms, and insurance documentation, and review of outstanding balance and copays. Insurance eligibility verification confirms if insurance coverage is valid on the date of service, shows patient responsibility for copays and coinsurance, identifies insurance payer and where to send claims, and tells prior authorization and referral requirements. This data can calculate accurate, upfront pricing estimates for patients. 

PracticeSquire connects healthcare systems, benefiting patients, providers, and office staff. Patients are given cost transparency and easily accessible information. Providers get reduced administrative load and greater productivity, and office staff eliminate mistakes and rework claims from misread insurance cards, giving them more time to focus on other tasks. Automated insurance eligibility verification can save an average practice 11 hours of administrative time every day and up to $4,500 a month.