Episode 104 - The Complex World of Healthcare Payments - Ian Drysdale, Zelis Payments

Take a listen to Ian Drysdale of Zelis Payments and George as they discuss how complex the payments process is in the healthcare industry. 

 

Near the peak of payments complexity and specificity is the healthcare industry. If you’ve ever looked at an explanation of benefits letter from a healthcare insurer, you’ve had a glimpse into the complexity of these payments. Multiple parties are paid a lot of money, before you may be required to ante up a co-payment yourself.

Regulation, compliance, the huge range of services delivered, and the scale of the healthcare ecosystem—from giant healthcare insurers to the local dentist—make healthcare payments a challenging, and attractive, market to serve. It is an enormous business-to-business market. Americans spent $3.5T, over $10K per person, in 2017. We spend something like 1 in 6 of our dollars on healthcare.

Simply getting the payment to the right party is complicated. Consider the imaging clinic that operates within a big regional hospital. It has its own back accounts, its own P&L, its own accounts receivable. Getting payments routed into the right account isn’t easy.

Checks still dominate in this industry because the development and maintenance of databases to track bank accounts is a major headache for a payer like an insurance company. Dropping a check in the mail, along with invoice information, at least communicates what’s necessary despite slow speed and high cost.

That’s where Zelis Payments and Ian Drysdale, its president and guest on this Payments on Fire® podcast, come in. Zelis Payments specializes in shifting healthcare payments from check rails to ACH rails. Using the service, providers get paid within a two or three days instead of two weeks. That speed has a huge impact on cash flow, a business metric of particular importance to smaller providers.

Zelis Payments also enables an EDI message format that communicates what’s being paid for in a manner consumable by the accounts receivable software in almost every healthcare provider’s office. Matching up the ACH deposit to what it covers is automated. While neither ACH or EDI are considered modern technologies, pairing them tightly produces real efficiencies.

Another area of complexity Ian discusses is healthcare fraud. Unfortunately, no small number of providers enter fraudulent claims into the system. They add up to huge numbers.

Zelis Payments adds value specific to the healthcare industry around the general functionality of EDI and ACH rails. If you’re a dentist getting paid 10 days faster than before, that added value is a very good thing.