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Unlocking Healthcare’s New Digital Age Involves More Streamlined Patient Refunds Processes

July 31, 2023

Healthy money movement is essential to the healthcare industry.

The knock-on effects of quick and seamless transactions move beyond the payment occasion to encompass the entire healthcare delivery process, from appointment to documentation and beyond.

That’s why PYMNTS CEO Karen Webster sat down with Ingo Money CEO Drew Edwards and KeyBank Senior Vice President and Head of Healthcare and Insurance Pete Wheeler to talk about digital innovation in the healthcare space.

“What healthcare providers are trying to do here is build out a better patient experience from a payments perspective,” Wheeler said. “Everybody is accustomed to digital payment experiences, but that’s not necessarily what you get in the healthcare space.”

A widening gap between what private insurance covers and what consumers pay for healthcare has driven the need for improved payment solutions.

And as consumers bear a greater financial burden, healthcare providers are striving to enhance the overall patient experience, not just in terms of medical care but also from a payment perspective, particularly as it relates to the processing of patient refunds.

“Patient refunds are left out of the center of healthcare’s process of digitization,” Edwards explained.

“It’s amazing how much the backlog is or the lack of the sense of urgency is in terms of getting those refunds to patients,” he added.

Streamlining the Refund Process

While online payment capabilities have been developed and integrated across many crucial sectors over the past decade, patient refunds have not been a top priority for digitization.

Currently, patient refunds are often handled manually, with checks being sent through the mail, which can be a costly and time-consuming process for healthcare providers and insurers and a frustrating one for patients.

Despite the present situation, digitizing the refund process “seems to be perceived as one of the easier problems to solve,” Edwards said.

“The healthcare claims adjudication process is not a short process,” Wheeler said. “The bottom line is you end up with a payment refund that might be associated with a transaction that was six months old, eight months old. It’s really, I think, a timing issue and just how quickly you can get that information to turn it around.”

Many companies outsource the storage of consumer payment data to third-party service providers, making it difficult to effectively reach out to patients or members for refunds. The lack of integrated data and connectivity between systems further compounds the challenge of issuing ad hoc refunds digitally.

“In older industries — healthcare being one of them — there’s a bigger gap than you would think to interact with an [application programming interface (API)],” Edwards said.

By streamlining the refund process and implementing instant payment solutions, healthcare providers and insurers can improve patients’ financial experience and enhance their overall satisfaction with the healthcare system, making it an attractive area to target.

Solving for Technical Resource Scarcity in Healthcare

Healthcare providers often face challenges when implementing major projects due to the scarcity of technical resources. However, removing this scarcity can bring significant benefits and open new opportunities. API integration in particular plays a crucial role in streamlining processes and improving efficiency.

Edwards noted that KeyBank has done “wonderful work” translating batch information for its clients into Ingo Money’s API format.

Wheeler explained that “every time we talk to healthcare, whether it’s on the insurance side or the provider side, technical resources are always very scarce. And getting any type of major project, whether it’s API integration, things like that, it’s very difficult. Taking away that blocker is a big benefit because it becomes a byproduct of their current process.”

Both executives noted that macro factors may help move digitizing patient refunds up the priority list for healthcare players.

“We are in that economic cycle where every cost you can beat out of the process is necessary right now,” Edwards said. “For insurance and healthcare, how to save money and how to eliminate those manual steps in the processes is top of mind.”

“I’ve been doing this for north of 20 years, and it’s been an issue all along,” Wheeler added. “And insurance has only gotten more complex, and the payment process has only gotten more complex. I don’t see refunds going away; I see them getting greater as time goes on.”

“We’ve had plenty of conversations with the health plans that are eager to figure out ways to eliminate the check printing process that they have, especially as they move away from paper claims payments,” he explained.

“It’s just an old-school way to do things in a very competitive environment,” Edwards said. “Someday the checks will go away. Maybe not while I’m alive. But pretty much everybody that’s producing a lot of them is working to reduce or eliminate them somewhere in their priorities.”