Exchanges pose billing, collecting challenges for insurers


Although health insurance exchanges represent a considerable new source of revenue, they also pose significant new billing and collecting challenges that insurers must sort out before they can realize those financial benefits.

Most consumers shopping for individual coverage on an exchange will be receiving federal premium subsidies that vary based on each consumer's income. Most insurers, however, don't have adequate billing systems to properly adjudicate subsidy payments, Mark Waterstraat, chief strategy officer and co-founder of payment processing company Benaissance, told AIS Health.

Add to this, 80 percent of exchange consumers will pay the balance remaining after the subsidy by check or cash equivalents, potentially from multiple sources, including the member, a relative or charity.

"You might send them a clean bill, but what you get back could be a jumble of payments for various members of the family," Waterstraat said. He suggested insurers place partial payments received into a "custodial cash account" until full premium payment is collected.

Considering insurers inaccurately process one in 10 medical claims, as FierceHealthPayer previously reported, they may need to improve their claims processing systems. Indeed, Waterstraat recommended insurers improve their IT systems so they can process several payments while assigning them to the correct premium.

And despite shying away from accepting debit and credit payments in the past, insurers should consider using these payment options, particularly so they can provide consumers with the option of automatically deducting premiums from a bank account, he added.

To learn more:
- read the AIS Health article

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