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.

Benefits 

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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Healthcare Payment System Development Services

Industry

End-to-End Healthcare Payment Solutions Development

  • Assessment of Provider Requirements Based on Services
  • A Consolidated Platform To Carry Out All Operations Surrounding Healthcare Payment Processing
  • Extensive Quality Testing To Ensure Functionality
  • User-Friendly UI/UX Design and Development
  • HIPAA Compliance For Protecting Privacy and Integrity of Sensitive Data
Industry

Custom Healthcare Payment Systems Development

  • Development of Healthcare Payment System To Match the Needs of Different Types of Providers
  • Provider-Specific Modules For Automated Charge Capture
  • Insurance Verification Function Within the Health Care Payment System
  • Streamlined Payments Processing and Insurance Payment Posting For Providers
  • Integration Of Healthcare Payment System With Existing Systems
Industry

Consolidated Healthcare Payment Solutions For Hospitals

  • Function For Processing Bundled Payments Within the Healthcare Payment System
  • An Aggregated Dashboard For Administrative Oversight of Financial Status
  • Module For Managing Accounts Receivables
  • Automated Medical Coding Feature For the Healthcare Payment Processing Platform
  • Patient Management To Track All Medical Services For Streamlined Billing

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Frequently Asked Questions

Payments in healthcare are financial reimbursements made to providers, hospitals, or clinics for medical services rendered to patients. The payments come mainly from insurance payers, with a portion also coming from the patients as out-of-pocket payments. Healthcare providers send a summary of their services in the form of claims approved or denied by payers depending on the circumstances.  

There are four types of payment models in healthcare –   

  • Fee-For-Service – Physicians are paid for every medical service they provide. This includes every test, prescription, and consultation. This is the most prevalent payment mode in healthcare.  
  • Capitation – Physicians are paid an established amount for every person enrolled each month  
  • Discounted Fee-for-Service – This is similar to the fee-for-service model. But the difference is that physicians are paid an amount at a pre-established discount of the usual price they charge.  
  • Salary – This is usually for physicians working at hospitals. They are paid a fixed weekly or monthly amount irrespective of the number of enrolees or services they provide.  

There have been calls for a value-based model of healthcare payments in light of the growing costs. One example of a value-based payment model is bundled payments. This involves payment of a pre-determined amount for an episode of care to all the providers involved.   

1. Fee-For-Service – As the name indicates, it reimburses providers for every medical service rendered to patients. This includes consultations, tests, scans, and prescriptions. It is the most prevalent healthcare payment model in the United States., and is generally considered the main reason for high healthcare costs.  

  

2. Capitation: Providers are paid a fixed monthly amount for every enrolee in this model. Capitation provides incentives to reduce care costs due to the fixed budget of the health plans allocated to the enrolees. Physicians stand to incur financial risk if the cost of care they provide is more than the monthly payments they receive.  

  

3. Salary: Providers paid in salaries are usually paid by an organization they work for, like a hospital. They face no financial risk or are incentivized to alter their treatments to suit health plans. However, their employment might offer incentives based on performance in addition to bonuses.  

The main types of payments in healthcare are –   

  • Fee-For-Service  
  • Capitation 
  • Discounted Fee-For-Service  
  • Salary  

In addition to these, there are other lesser-used payment models in healthcare. They are –   

  1. Bundled Care – This model simplifies medical payments in case of pre-arranged medical procedures. It is applied for a single episode of care in which multiple providers offer associated services for a medical problem. The single bundled payment gets split amongst the providers for their services.  
  2. Accountable Care: An accountable care organization (ACO) is a group of healthcare providers and hospitals coordinating care. They have checks and balances to prevent unnecessary or redundant services and help keep the costs relatively low.  
  3. Health Maintenance Organizations – Healthcare maintenance organizations (HMOs) are a network of providers and healthcare organizations contractually obliged to offer medical services for members of associated health plans. Members of these plans are incentivized to stick to providers and organizations in the network.  
  4. Preferred Provider Organization: These are similar to HMOs, with one difference being that they will incur high out-of-pocket costs for going out of network for care.  

As the name indicates, the value-based payment model in healthcare pays the providers for the quality of care they provide instead of the quantity of care. In other words, the amount reimbursed to providers depends upon the clinical outcomes of the patients. This is in contrast to the conventional fee-for-service model of healthcare reimbursements, in which providers get paid based on the number of services they provide. The number of services includes tests, scans, prescriptions, and consultations.  

The fee-for-service model provides incentives to providers to provide more services, some of which might not be necessary or even redundant. This ends up increasing the cost of care. On the other hand, the value-based model emphasizes patient outcomes. It has been touted as an effective means of reducing the increasing healthcare costs.  

Software technology for healthcare payments streamlines the entire medical billing and payments process. They replace pen and paper-based workflows with digital ones, accelerating everything while ensuring data security.   

Insurance verification software speeds up verifying health plans, reducing waiting times for patients who need crucial surgeries. Coding and claims management software carries out automated coding, claims scrubbing, and claims tracking. This minimizes the number of claim denials, improving providers’ revenue cycles.   

Payment processing software enables providers to manage all payments with electronic invoices and bills. Additionally, flexible payments for healthcare help more people avail important medical services. These are made possible with financial technology solutions dedicated to healthcare payments.  

In light of the growing costs of care in the United States, people and governments have been calling for reform in the system. As a result, there have been distinct trends observed when it comes to payments in healthcare –   

Calls for Transparency in Prices  

The spending on healthcare in the United States has reached $4 trillion. It is more than the economies of most nations. The costs of care and insurance have been climbing steadily, and patients end up with higher premiums, co-pays, deductibles, and out-of-pocket costs. In light of this, there are growing calls for transparency in the pricing to help people decide better.    

Value-Based Reimbursement   

This form of medical reimbursement bases the medical payments on the quality of the care instead of the number of care services. In other words, it will incentivize providers to focus on facilitating better patient outcomes instead of paying them for every service provided. This will help reduce the cost of care and make it more accessible. It focuses on the value derived from the care services.    

Retail Medicine  

In response to the growing costs of care and difficult accessibility, there have been clinics inside grocery stores and pharmacies that offer services like flu shots, immunizations, and others. The best part is that these are more flexible and accommodating to different payment methods. Retail medicine has been growing in popularity.  

Digital technology streamlines the operations of every industry it touches. The same applies to healthcare payments. Technology solutions replace paper-based processes with digital ones, increasing the speed, productivity, and security of all payment processes. In other words, things that needed managing physical documentation and paperwork can now be done with a few clicks.  

Additionally, healthcare payment technology introduces transparency and accountability as it facilitates audits. The best part – most healthcare payment platforms also include features for analysis to assess all the various payments for deriving actionable insights.  

Automation reduces the need for manual human intervention in workflows. Regarding healthcare payment and associated activities at hospitals, automation goes a long way in speeding up processes, boosting productivity, and minimizing errors.   

Automation works for all the processes that are repetitive and don’t require conscious decision-making. Hospitals can automate these tasks, save up on overhead, and increase the speed significantly. Since a software application would handle the targeted operations, there won’t be any errors. To sum it up, automation in healthcare payment increases the speed of workflows, reduces operating overhead, minimizes errors, and maximizes overall efficiency. 

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