The payer-provider cycle: Seeking a better future

Since the Affordable Care Act (Obamacare) was signed into law in 2010, its provisions initiated wide-spread changes to the U.S. health care system, including system performance, individual mandates, health exchange and efforts to improve cost containment in an overall attempt to reduce spending across practices.

Despite the many provisions intended to reduce costs provided through the Act, system-wide healthcare costs are still projected to rise faster than the national income for the foreseeable future, according to Kaiser Family Foundation research.

 

Economists note that it’s the health care providers that are experiencing the heavy brunt of cost increases. Reductions in Medicare spending in 2014 alone was at $54 billion, but were reductions in cost increases only, according to the Centers for Medicare and Medicaid Services.  Experts suggest that hospital’s costs are rising faster than their Medicare revenues, which could lead to further spending increases and may force providers to skimp on staffing and care, affecting complete patient care.

The case for reducing bureaucracy and inefficiency in administration and strengthening collaboration in the payer-provider relationship is more vital than ever before in the health insurance marketplace. Experts urge that if 10%-20% of the inefficiency and paperwork that is generated back-and-forth between providers and payers is removed, administrative costs will drop, and ultimately, patient care will improve as practitioners will not be burdened with repetitive claims denial and appeal cycles.

Leading health care revenue cycle management (RCM) companies, as well as business process management (BPM) providers like DDC are working to keep providers in compliance with mandates posed by the ACA, and simplify the insurance administration and claims process rulings that came into effect just last year.

With the remittance patient population on the upswing, RCM companies are increasingly benefiting from higher quality data and improved turnaround time by integrating customized software through BPM vendors to achieve the highest quality assurance and post-processing for remittance offerings in addition to unique revenue cycle visibility.

DDC’s back office solutions utilize advanced technology to re-design business processes for our clientele across the globe as demonstrated in a case study, available by request at This email address is being protected from spambots. You need JavaScript enabled to view it., in which The DDC Group was selected by a leading RCM company to create a business process management solution to streamline its model.   

Partners like DDC who have widespread knowledge in the full range of claims processing, are the ones who will safeguard the healthcare insurance market by providing service delivery models that strengthen the payer-provider relationship, making it more efficient and profitable than ever before.

 

To learn more about how you can alleviate administrative burdens imposed by ACA mandates, and enhance service delivery opportunities for your company please contact John Eisele, DDC’s resident healthcare insurance expert, via telephone at (770) 653-5052 or email at This email address is being protected from spambots. You need JavaScript enabled to view it..

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