Times are Changing. Can Your Payment Processing Solution Keep Up?

Just five years ago, the majority of healthcare organizations would tell you that they needed payment technology optimized for fee-for-service (FFS) arrangements. In 2018, only 5% of healthcare payments were population-based, with the remaining 95% structured as FFS.

Now? The situation is dramatically different. A significant number of payers and providers are engaged in full or partial capitation arrangements, requiring a fully different payment technology from FFS.

The real-life considerations of payment processing solutions

Consider a typical revenue cycle manager at a large healthcare organization—let’s call her Mary. Mary needed to evaluate a payment technology solution that would ensure long-term success with capitated payment agreements. She knew that locking into a costly legacy claims processing solution could be a risky approach that limits the organization’s ability to scale into alternative payment models.

What’s Mary going to be looking for to make her job as headache-free as possible?

• First, she’ll want a software solution that is future-proof, with expertise in value-based care alternative payment models, in addition to fee-for-service;
• She’ll need a solution that will help increase the efficiency of her financial managers with automated pre-authorizations, claims adjudication, and payment reconciliation;
• And to avoid revisiting the issue every few years, she’ll look for a solution that’s dedicated to ongoing enhancements and product improvements, taking continued industry trends into account.

By incorporating a new payment technology, like Cedar Gate Capitation Adjudication, what should be the expected results? There are many, including increased automation and precision of repetitive tasks like claims data management, payment processing, and reimbursement. Alongside this, the revenue cycle manager should be able to handle more accurate and timely payment data and reconcile capitated payments with the payer.

Change is a feature, not a bug

When the right solution is implemented, it can deliver numerous benefits to providers and payers alike, like the ability to:

• Reduce administrative costs
• Automate repetitive tasks
• Boost efficiency and minimize waste
• Manage payment reconciliation

Flexible payment technology solutions can improve the patient experience by delivering timely and accurate information on coverage and costs while streamlining the entire adjudication process.

The evolution of payment technology in healthcare has certainly introduced a variety of challenges, particularly with the shift towards capitation arrangements. But long-term success can be achieved with the help of a payment technology solution that has a deep grounding in value-based care alternative payment models and a commitment to ongoing product improvements.