TAWPI News & Events

Achieving Success In Healthcare
Payments Automation

TAWPIs Healthcare Payments Automation
Summit Review

By Mark Brousseau

The United States spends a larger portion of its gross domestic product on healthcare than any other nation about 13 percent according to the Centers for Disease Control (CDC). Healthcare expenditures totaled $1.3 trillion in 2000 alone, the CDC estimates. While 87 percent of these expenditures were related to delivering health care, 6.2 percent went to administrative and management costs. That means the healthcare industry spends approximately $80.6 billion per year on administrative and management costs.

Its little wonder then that healthcare organizations are desperate for new ways to reduce the expense and inefficiencies associated with healthcare payments processing. Nearly 200 participants converged at the Westin in downtown Chicago, September 15-17, to attend TAWPIs first ever Healthcare Payments Automation Summit (HPAS), and hear educational sessions and panels on the latest technologies and processes in healthcare payments.

Healthcare payment processing is one of the most lucrative markets in receivables processing, but it is also the most complex and labor intensive, commented Kathy Strasser, executive vice president of Remittance and ECM Solutions for WAUSAU Financial Systems, a sponsor of the HPAS. At the HPAS, WAUSAU debuted ReceivablesWorksRX, a solution which facilitates management of the healthcare revenue cycle and addresses the needs of healthcare payment administration. WAUSAU also participated in several sessions.

We expect more healthcare organizations to deploy automated technologies to support EOB processing and records management streamlining compliance and claims-to-cash processes, improving productivity, and enhancing customer service, said HPAS attendee Ed Pearce, executive vice president of sales and corporate development for Dallas-based eGistics, Inc.

Among the speakers at the HPAS was Jim Ribelin, CEO of San Diego-based HERAE, LLC. Ribelin told attendees that he wasnt surprised by the groundswell of bank lockbox providers interested in offering healthcare payments processing services. With the advent of Client Relationship Management software and client database mining reports, banks recognize the revenue-related benefits of targeting particular industry niches, he said. And only one industry seems to weather the volatility of the domestic and global markets healthcare.

Ribelin noted that just a few years ago, only the largest banks were targeting the largest healthcare providers with payments solutions. Concurrently, non-bank players began to emerge to address the remittance needs for large and mid-sized provider organizations. Now, more banks are focusing on payer payment solutions to help their healthcare clients substantially reduce the associated administrative costs. And its not just big banks.

Recently, regional banks have seriously begun to identify the benefits of industry-focused product development or strategic technology partnerships to provide remittance solutions to their healthcare clients, Ribelin told attendees. Even smaller players are in varying stages of exploration within this space. Typically, they target smaller healthcare companies.

Ribelin said some of the largest banks are acquiring their healthcare solutions outright via company acquisition. He said there are some important considerations for banks thinking of this option, including the complexity of system integration projects, potential employee fallout/transitions, and the possible loss of technical expertise to more agile competitors.

Meantime, other banks are attempting to build their own proprietary healthcare payments systems, Ribelin said. Generally, they run into challenges such as staff having limited technical knowledge and expertise in the healthcare space; bank bureaucracy that can stymie healthcare payment projects; cumbersome bank processes that cannot accommodate shorter project timelines; and a lack of specialized customer support.

He said other banks are pursuing strategic partnerships with technology companies that specialize in critical parts of the healthcare payment stream. Ribelin said these white-labeled products provide shorter time to market, less infrastructure to acquire and maintain for banks, less training downtime, and minimal bureaucracy for development.

Healthcare payment industry expertise and knowledge is available to support the processes of implementing the solution on both the enterprise and client level, Ribelin concluded.

And TAWPIs HPAS is a good starting point for these banks.