Healthcare Payments: New Business Opportunities for Financial Institutions

Financial institutions and third-party processors have much to gain from the healthcare changes that go into effect January 1, 2014. With federal deadlines looming and so many providers and health plans seeking solutions, the market is ripe for financial institutions to not only help healthcare entities find solutions, but to impact their bottom line as well.  

Here are a few of the challenges facing the healthcare industry, along with the business opportunities they represent.

Complying with the EFT & ERA Operating Rules

For health plans, compliance with the healthcare EFT Standard and EFT & ERA Operating Rules is mandatory under the Patient Protection and Affordable Care Act (ACA). In addition, health plans must certify their compliance with the Secretary of Health and Human Services no later than January 1, 2014.

Because many small and medium-sized health plans or third-party vendors do not currently offer reimbursement of claims payments via ACH, financial institutions can help existing and new customers comply with the healthcare EFT standard by the January 1 deadline by offering them ACH Origination services.

Requesting the Healthcare EFT Standard

According to HIPAA (45 CFR 162.925), providers have the right to request the healthcare EFT standard from their health plans. Providers that want to receive ACH for claims reimbursement will also need to receive the TRN Reassociation Trace Number included in the CCD+ Addenda Record Payment Related Field.

The NACHA Operating Rules (Subsection 5.1.5.3) mandate that RDFIs must be able to deliver this information to the provider, if requested, by the opening of business on the second banking day. Further, they must be able to offer one secure electronic delivery option for the TRN Reassociation Trace Number.

Because so many healthcare entities remain unaware that they have the right to request the healthcare EFT standard, financial institutions should consider reaching out to existing customers, informing them of this option. The low cost of EFT, when compared to other forms of payment, make it a draw to potential new customers as well.

Improving Cash Flow and Managing Risk in Back Office Operations

Business opportunities are rife for ODFIs and RDFIs to help health plans with ACH Origination and to assist providers with improving cash flow and managing back-office risk. For example, providers have concerns about unauthorized debits to their DDA accounts if they choose to accept ACH credits for claims reimbursements. It’s a perfect opportunity for RDFIs to offer Debit Filters, Debit Blocks, ACH Positive Pay, and account masking services like UPIC accounts and other options to providers, helping them mitigate risk and improving cash flow in the practice.

In addition, health plans need treasury services to provide ACH Origination. Consider offering these and other treasury services to improve cash forecasting and treasury management.

The ways in which financial institutions can maximize business opportunities while helping healthcare entities are endless. The solutions that financial institutions can offer not only benefit health plans and providers, but the bottom line as well.