Looking back a decade, the industry landscape appeared much easier for healthcare payers to navigate. Change came gradually, market share was high, and product offerings were simple. Inrecent years, unprecedented changes in legislation, competition, and new offerings and marketsegments have turned the industry on its head. Planning cycles are shorter, volatility prevails, and adaptability is the new imperative.
As healthcare payers analyze their business processes and IT infrastructure, the vast majority arefinding themselves constrained by aging and inflexible legacy billing systems, which limit their ability to capitalize on new markets, respond to competition and legislation, and improve operational efficiency. This has led many healthcare payers to consider replacing their existing billing systems with a modern, rules-driven enterprise solution that delivers insurance-specific functionality—and can yield both shortand long-term benefits.
Unlike other major IT projects, billing projects are able to rapidly generate significant return on investment (ROI). This makes sense when we consider that the easiest way to increase revenue is to target the system directly responsible for billing and receiving revenue. Billing projects can rapidly reduce processing expenses, improve cash flow, and increase customer satisfaction. A modern realtime billing system with electronic bill presentment and payment (EBPP) capability leads to a reduction in late payments and increases your cash on hand. This faster bill generation and delivery also translates to more accurate billing and hence happier customers, as lag time is reduced. Automation of cumbersome, manual processes, such as detail reports that support the invoice and cash application, can reduce clerical expenses while speeding up revenue recognition. Automation of the collections process, through automated dunning letter generation and workflow management, can translate to enormous and immediate gains. This is particularly significant as Health Plans shift business from the group to individual market. A mere 1% improvement in collections for a payer with a billion dollars of annual revenue will pay off 10 million US dollars annually. While billing may not always be an explicit requirement when a new customer selects a healthcare payer, cumbersome or inaccurate billing can quickly lead to customer dissatisfaction, increasing customer churn and creating difficulty selling additional insurance products into existing accounts. Deploying a modern billing system, such as Oracle Insurance Revenue Management and Billing for healthcare payers, can play an integral role in helping healthcare payers increase business agility, brand awareness, reduce costs, and better serve their customers.