Matt Nachreiner's dermatology office now operates a lot more like an e-commerce portal, a rapid change that's put lots of money on the line.

The acceleration of the Affordable Care Act, along with the longer trend toward consumer-directed health care finance and high deductible plans such as health savings accounts, are decentralizing health care payments—with consumers responsible for managing more of their health care expense and providers managing more payment processing at their offices.

"The whole collection of payments has become more difficult," said Nachreiner, the practice administrator of Sanova Dermatology in Austin, which is turning to cloud-delivered technology to manage its diverse payments needs. "There are a lot more insurance and billing rules."

Sanova has deployed a hosted technology payments produce that integrates with its medical practice management system. Called CareCloud Patient Payments, the system uses connected card readers and stores payment card credentials on file for faster and more digital payment options that are tied to a patient's existing file.

The system is designed to replace what had been a manual practice that was much easier when most payments were reliably covered by an insurer.

The shift in health care billing trends have been building for a few years, but are now accelerating quickly, Nachreiner said, adding there's a tangible business risk if practices can't keep up. Greater patient cost sharing means harder accounting, and more of a burden on providers to take payments in the office, Nachreiner said.

"We do a lot of procedures in office, and if we weren't able to collect at the point of service, we'd lose tens of thousands of dollars per year," Nachreiner said.

The new process differs from managing a physical point of sale because it supports a wider range of payment and financing options.

"There's lots of financial burdens on patients," Nachreiner said. "If it's a $2,000 bill for a skin cancer surgery, they can't always pay for that right away, so having an account gives the flexibility to break up those payments and create a schedule with a lower workflow for the staff."

Amazon and Facebook, which leverage registration and existing data for faster repeat transactions, are the models for CareCloud Patient payments, said Juan Molina, the vice president of strategy and business development for CareCloud, a seven-year old Miami-based general health care management technology company which took its payments portal out of pilot earlier this month.

"The patients have to opt in, but there is the option to process payments off of a card that's on file, you don't have a third party doing that and the experience isn't disjointed," Molina said. "It all works off of the same application."

Health care payments are a huge market that's becoming a popular target for technology companies, given the rapid growth of out-of-pocket transactions, which have more than doubled in less than a decade. Providers are also responding to pressure to add low navigation online options and installments for larger bills.

"The providers aren't asking for $50 anymore, they're asking for a couple thousand dollars," said John Adractas, chief growth officer at Simplee, a health care payments and financial management company, who adds the health care customer experience has not quite caught up to that of other industries, though there's been an acceleration in the past year.

"There is a huge gap on the technology side, to create a simple experience. Ideally, we'd all like to move the market off of paper and more toward self-service," Adractas said. "The airlines have done this and the financial institutions have done this. What would your response be if someone told you you'd have to stand in line at the airport to find out how much you have to pay for a flight and make that payment there?"

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