Commercial Healthcare

Written by Kimberly Clark
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The term commercial healthcare payer or provider pertains to the privately held sector of the health care market. Whereas there are rigorous restrictions on who can and cannot participate in government funded programs, commercial health care is readily available to the public. However, according to the Census Bureau, approximately 45 million Americans lack health insurance coverage.

Although there are many plans to choose from, the increasing cost of commercial healthcare is putting it out of reach for many people. Unfortunately this seems to be the case even for those that are working, because many businesses, especially small ones, are finding it increasingly difficult to provide healthcare coverage to their employees. In fact, according to the administers of the Medicare program, within the century, the growth in per capita health care costs is expected to surpass the per capita economic growth by more than half.

Commercial Healthcare Options
To keep their costs down, HMOs have very restrictive rules on the healthcare providers their participants can see. Patients are only allowed to use doctors that are a part of the HMO network and upon enrollment they are required to select a primary care physician (PCP), who has to formally refer them to any specialists. This can cause myriad billing headaches for hospitals.

Having a software system that can determine eligibility for coverage prior to billing can prevent a large amount of these problems. Fewer claims will be rejected, and the bottom line can be maximized. If you invest in a program that can handle data and documents as well, you can severely cut down on issues of liability as well, since all changes to and viewings of records can be tracked.


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