Health Payment Systems

A healthcare payment system is a software solution that digitizes the entire lifecycle of payments in the healthcare industry, either partly or completely. As there are multiple forms of reimbursing providers, software solutions for each go a long way in streamlining the process-flows of healthcare reimbursements between the patients, providers, and payers. Platforms for healthcare payment processing reduce the operating overhead for providers, minimize the possibility of errors through automation, and facilitate accountability across healthcare payment workflows.    

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It is a well-known fact that healthcare payment systems shouldn’t be one-size-fits-all. Every healthcare provider organization has special needs, rules, departments, and systems. It is required for such healthcare organizations to have healthcare payment systems that fit their specific needs and offer a streamlined payment management workflow. With seamless health payment systems, healthcare organizations, whether they are a small clinic or hospitals, can run their practice smoothly by serving their patients better and getting paid faster. All simplified healthcare payment systems are at the core of a healthcare facility’s revenue cycle management operations.

OSP has extensive experience in building healthcare payment systems for multiple provider organizations, even for specialty practices. The specialty billing is one of the challenges faced by even the top-notch medical billing solutions. But OSP can solve the specialty payment needs with highly tailored health payment models. We help with integrated healthcare payment solutions that help you run your health practice more efficiently, improve the patient experience, and improve retention. We can customize healthcare payment solutions for medical and dental payment processing, optical payment processing, veterinary payment processing, and more. We customize the healthcare payment models for your needs with payment processing designed to integrate seamlessly into your current healthcare payment systems and practice management.

The insurance eligibility verification is obtaining the patient’s information to ensure that the patient has the insurance coverage; services that are being provided are covered. Having verified the patient’s insurance eligibility beforehand helps to minimize the denials and appeals and payments are expedited at the appropriate rates. Healthcare payment systems cannot function smoothly for their goal without proper insurance eligibility verification. A healthcare cloud based module for insurance eligibility verification integrated into your practice management system is the first step towards well-functioning health payment systems. 

OSP has worked for the practice management systems to build insurance eligibility verification from scratch to be integrated in healthcare payment systems. We can customize your healthcare payment solutions with advanced insurance eligibility verification to help with API, batch processing, and single patient solutions. To help practices with Medicare health payment systems with MBI Lookup, and SNF Billing NPI, patient estimation, and claim status features. We can tailor suitable healthcare payment systems that can streamline front-end insurance eligibility and benefits verification and back-end claim status and billing solutions, increasing efficiency and revenue from all ends. Insurance verification makes the healthcare payment systems efficiency complicated, with patients taking on more payment responsibility and continually changing insurance providers. You need to identify coverage fast and reduce the number of claims being denied on the back end due to inactive insurance or non-coverage. OSP’ has helped many healthcare provider organizations with top-notch healthcare payment models to be part of their current healthcare payment systems.

A healthcare digital wallet in electronic healthcare payment systems that allows patients to store payment data electronically to make health payments online. Digital wallets are quite common, and most people already use electronic digital wallets for a number of purposes like shopping on eCommerce websites. The healthcare payment systems of digital wallets simplify the online payments by storing a patient’s payment data, and preferences for any future uses. We understand that nobody likes to dig out their credit card and enter their lengthy account number with billing addresses every time making a payment. Whereas when healthcare payment systems are built with a digital wallet, it automatically populates all the payment information at check-out and makes the tedious payment process faster and simpler.

OSP can help you get away from the traditional and manual healthcare payment systems that are paper-intensive. The healthcare payment models with paper-intensive quality are also labor-intensive processes. So, if you are following traditional healthcare payment systems, you are not only spending too much on paper but also, you need a staff to handle these processes. Such age-old paper-based systems add to the operational cost with the hard costs of paper and postage. OSP can build healthcare payment systems for your needs that can store multiple payment methods and preferences, including the information about automatic payments, payment plans, and maximum payment limits. We have helped multiple healthcare payment models with modern digital wallets capable of storing communication preferences, of knowing whether a patient is enrolled for eStatements or simply the text message communications. You can replace paper-based healthcare payment solutions with eStatements. By customizing the modern healthcare payment system, you can have cost containment and save operational costs by replacing the phone tracking down payments, mailing payment reminders with helpful text message reminders, and delivering instructions automatically.

Healthcare organizations are aware of the obligation of their patient’s personal, medical, and financial data secure. But keeping the patient health information (PHI) is not easy, and there are various strict requirements mandated by the Health Insurance Portability and Accountability Act (HIPAA) to be followed while building healthcare payment systems. As per the HIPAA guidelines, the healthcare providers are needed to keep all the personal health information safe and secure, including the information needed for the healthcare payment models such as credit card number and date of birth. While building healthcare payment systems, it is essential to make everything to be accessible across the globe. The health payment systems infrastructure has to be scalable to support large healthcare networks as well as accountable care organizations (ACOs). 

OSP can easily customize healthcare payment systems for your needs that are scalable, secure, and totally HIPAA compliant. We also ensure to comply with PCI DSS compliance while building healthcare payment solutions. The PCI DSS compliance is in sync with the system’s core parts that process, store, or transmit cardholder data. We understand the full scope compliance activities associated with healthcare payment systems, patient payments, including HIPAA, PCI DSS, and other mandatory compliance frameworks. Our team of experienced experts can assess ways to lessen the exposure and associated liability under these compliance frameworks, including the adoption of foolproof network safeguards and other de-scoping strategies. In order to keep your healthcare payment systems safe and secure, we customize frameworks that continually re-evaluate the range of compliance and foster new strategies or defenses to militate against the perils of non-compliance or breach.

Bundled payments are also known as episode-based payments. Bundled payments are the reimbursement of healthcare providers based on predicted costs for clinically defined care episodes. Since the implementation of ACA, bundles payments have grown into popularity. They have been used as a health payment systems strategy for decreasing health care costs through the efficiency of care. Modern healthcare payment systems focus on automating the bundled payments to make health care payments faster and hassle-free.

OSP can solve your healthcare payment models challenge by configuring a customized rule-based payment engine that works with your pre-defined claims management workflow and automates bundled payments. We can work on engineering healthcare payment systems for your care facility from scratch by combining clinical dashboards and claims transaction functions and support prospective payment programs at scale. To reduce the administrative and medical costs in health payment systems, episode-based payment monitoring is highly essential. We can engineer a health payment solution with advanced analytics that allows episode analysts to compare program definitions to actual claim data and recognize trends with summary and detail reports. You can get a clear and consistent view of key performance metrics associated with episodes from visual dashboards. With our smartly customized healthcare payment systems, you can simplify claims adjudication quickly and accurately to all the providers included in the care episode.

Prospective Payment Systems (PPS) is a reimbursement method in which Medicare payment is made based on a predetermined, fixed amount in healthcare payment systems. The healthcare payment amount for selective service is determined based on that service’s classification system. Ex. Diagnosis-related groups for inpatient hospital services. As per the CMS rules, the healthcare payment systems should leverage separate PPSs for reimbursement of different billing. There are multiple PPS systems in healthcare payment models for home health agencies, acute inpatient hospitals, hospice, inpatient psychiatric facilities, hospital outpatient, long-term care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities. 

OSP can customize state-of-the-art healthcare payment systems that incorporate the PPS to develop fair and defensible reimbursement rates for application of PPS methodologies for Medicaid payment strategies and Medicare Advantage. Health insurance companies share the risk with their provider network by leveraging the established framework of Medicare’s Prospective Payment Systems (PPS). This makes every group responsible for the portion of risk that they can efficiently manage. OSP can easily build customized healthcare payment systems that can analyze PPS rates on a national or regional basis, rely on accurate data in contract negotiations, and offer numerous state-specific rate files. Our healthcare payment systems help to reduce risk by effectively sharing, and managing, the risk of health care utilization.


Having spent over a decade designing and developing custom software for multiple industries, including healthcare, we know the workflows involved in medical payments. We devote time to understanding providers’ unique requirements and developing tailored healthcare payment systems. Our approach brings the benefits of digitization and automation into healthcare payments and goes a long way in optimizing providers' existing revenue cycle management activities.

Claim errors are one of the biggest reasons for delays, rejections, and claims denials. This is because filling out and submitting claims is tedious and only gets more complex as the hospital grows bigger. In light of this, OSP can build customized healthcare payment solutions to make it easier for providers to handle the claims workflows by automating the repetitive manual tasks and making it easier to track them.

OSP can build health payment systems to introduce automation into many medical billing and payment workflows. As a result, there is greater efficiency and productivity with fewer errors. This will reduce the overheads and also maximize the number of accepted claims. Subsequently, providers experience steady reimbursements, coupled with lowered operating costs. These factors will eventually add up to a significant improvement in revenue cycles.

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