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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Healthcare Payment System Development Services


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

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

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

Healthcare payment software automates billing to facilitate transparent and patient-friendly billing practices. It provides itemized statements and offers online payment options. The software sends real-time cost updates and checks insurance coverage and payment plans. The custom software offers a clear and concise reporting format in a well-organized layout. It conveys the necessary information in a simple language that is easy to understand, minimizing confusion and allowing patients to grasp their medical bills better.

A robust healthcare payment system has various features to improve the revenue cycle management and financial outcomes. These features include automated billing, real-time updates, online payment options, eligibility verification, insurance verification, claim tracking, compliance with regulatory standards, and more. Together, these features provide fast reimbursement, minimize claim denials, cut administrative costs, and improve patients’ satisfaction and financial operation.

Customized healthcare payment software solutions can support multiple payment methods by integrating with payment gateways that provide flexibility and choice. The various payment methods are credit cards, debit cards, automated clearing house (ACH) transactions, electronic fund transfers, checks, digital wallets, etc. Healthcare providers can use tailored payment software with selective payment methods that fit their unique business requirements. It allows patients to choose payment plans and frequencies of payment made.

By automating and streamlining the billing process, custom healthcare payment software solutions are crucial in minimizing billing errors, claims denials, and reimbursement delays. The customized solution facilitates claim submission, which reduces the risk of manual error. Some tools that OSP can implement are integration with existing EHR and billing systems, automated claim processing, medical coding and data encryption, custom reporting, eligibility verification, rejection analysis and resolution, and more. We are proficient in developing customized billing software solutions that can resolve your organization’s unique issues.

Yes, healthcare payment software solutions can assist in implementing value-based care models and alternative payment arrangements. The software can be customized to help reimburse under a fee-for-service (FFS) payment model and for a value-based care model, where value means the quality of care provided for the amount of money spent. It seamlessly supports transitioning from fee-for-service (FFS) to value-based care reimbursement. Such software can manage financial risk through alternative payment models, which focus on boosting provider collaboration, improving care quality, and making services more affordable.

After implementing our healthcare payment system, OSP offers continuous technical support for updates, issue resolution, and upgrades to enhance functionality and security. We provide regular training, compliance updates, performance optimization and customization services, integration facility with other systems, help desk support to address issues promptly, and more. We aim to offer customized support to the end-users, ensuring they can make the most of our provided software solutions.

Healthcare payment systems use various mechanisms to streamline and automate the claims processing workflow. It uses electronic data interchange and standardized coding systems like CPT and ICD-10 to ensure adherence to policy terms. The software automation helps receive claims, verify code procedures, inspect patient eligibility, and check for possible errors before claim submission. Then, claims adjudication software accesses claims for contract agreement, medical necessity, and coverage. Usually, claims adjudication software automates workflow and facilitates interoperability. These mechanisms enhance efficiency and boost the healthcare payment workflow.

The healthcare payment system follows different steps to handle the submission, adjudication, and payments. The process starts when the provider submits a claim to the insurance company. After submission, the adjudication process begins, where the insurer reviews the claim for validation and accuracy before determining the reimbursement amount. This process becomes crucial in deciding whether to accept or deny a claim if it contains any errors or reduce it if the provided service is not reimbursable. After completing the adjudication process, the insurance company pays the healthcare providers. Adjudication aims to ensure accurate reimbursement and promote financial stability in healthcare practices.

The healthcare payment system complies with Electronic Data Interchange (EDI) standards for healthcare transactions. By the HIPAA EDI rule, EDI transactions establish a uniform format for healthcare-related information exchange. Complying with EDI standards accelerates claims processing, enhances interoperability, and reduces errors by ensuring a structured information exchange between providers and payers.

The ease of integration between the Healthcare Payment System (HPS) and different insurance payers and networks can vary based on factors like standardization, technology compatibility, and stakeholder collaboration. Ideally, integration becomes relatively smooth if HPS and insurance payers obey industry standards like HL7 and Electronic Data Interchange (EDI) protocols. However, challenges may arise among different payers if there are variations in business processes, systems, and data formats. Effective integration requires a commitment to standardization and interoperability initiatives.

Yes, the healthcare payment system can provide detailed and itemized bills to patients. It outlines specific services received, associated costs, and insurance adjustments. Medical billing errors are common and can lead to overbilling and underbilling. A comprehensive review process may help in addressing billing errors efficiently. Providers may conduct internal audits, and patients can report discrepancies to the billing department. Insurance payers also play a vital role in error resolution by validating claims accuracy. Timely communication between patients, healthcare providers, and insurers helps resolve errors, ensuring transparent and accurate billing.

The payment system can accommodate different reimbursement models, but their flexibility depends on the specific context and goals of the healthcare system. Today’s modern systems are usually designed to integrate with varying reimbursement models like fee-for-service, bundled payments, and capitation. Some platforms manage multiple models seamlessly and offer adaptable configurations for evolving payment structures. But if it is about flexibility, it depends on the software or platform used. Some may be versatile in adopting different payment models, while others may not.

Yes, today’s healthcare payment systems can seamlessly integrate with mobile payment platforms to accommodate the rising trend of mobile transactions in healthcare. It provides a secure, user-friendly interface to connect with mobile payment services, facilitating patient transactions via tablets and smartphones. It aligns with digital solutions, promoting a more patient-centric approach to healthcare financial transactions.

The payment system employs data analytics for revenue cycle management by analyzing vast datasets to optimize billing processes, identify trends, and enhance financial performance. The intricacies involved in revenue cycle management (RCM) often lead to bottlenecks, inefficiencies, and revenue leakage, which can be effectively managed using data analytics. It helps transform RCM operations by encouraging data-driven denial management, allowing enhanced patient collection, efficient resource allocation, improved compliance, and revenue forecasting.

OSP can develop a customized healthcare payment software system to help organizations implement and optimize their healthcare payment systems for efficient billing, collections, and financial management. We can provide intuitive interfaces for effective billing, automate collections processes, and seamlessly integrate with existing workflows. The software uses advanced data analytics to optimize RCM. It reduces billing errors, provides data-driven insights, and promotes financial transparency. Continuous technical support is offered to address the raised issues.

OSP implements robust encryption, secure APIs and coding practices, and role-based access controls to ensure that healthcare payment systems comply with industry regulations, data security, and privacy standards, such as HIPAA. We conduct regular assessments and audits to identify vulnerabilities. We create risk management strategies to control the risk and minimize its effect. Teams are trained on evolving HIPAA regulations that guide how PHI should be securely sent, stored, and disposed of. Privacy measures are incorporated, and collaboration with compliance experts ensures ongoing adherence.

OSP can integrate healthcare payment systems with other healthcare software, like EHRs and billing systems, for seamless financial data exchange. Our tailored software adheres to industry standards like HL7 and FHIR, providing seamless interoperability solutions for financial data exchange. The integrated systems provide real-time data sharing, reducing manual input and errors. It enhances billing efficiencies and provides a comprehensive view of financial data. Ultimately, such integrations help improve patient care and healthcare finance management.

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