In today’s fast-paced healthcare landscape, changes in regulatory demands, increasing pressures from payers, and on-going market consolidation have all contributed to a myriad of revenue cycle challenges and considerations.
As healthcare organizations continue to face rising costs, creating and maintaining an efficient revenue cycle is more vital than ever. In doing so, many of today’s providers have focused their efforts on a critical RCM subset: compliance.
Due to a lack of resources and a shortage of patients, healthcare providers in rural communities encounter unique financial challenges compared to their urban counterparts. Along with revenue cycle management, all hospitals, regardless of size, must stay attentive to patient health and data analytics to monitor their overarching success.
Is the medical billing service you use causing your practice to lose revenue? Bad debt for medical practice is mostly caused by payer nonpayment, and many patients carry a past due balance for at least 60 days. If this appears to be the root of your practice’s problems, you may need someone who can analyze why claims for payment are being denied. Perhaps over time, you have noticed patterns in the revenue cycle which are not efficient or productive, causing the decrease in your practice’s financial performance.
You might be reluctant to make changes if you do not know specifically how to pinpoint the root of the problems and what to look for in a new service provider. Start by taking a closer look at the aspects of the process that your practice can manage, such as your patient volume, capacity and what you charge patients for your services. Also, it is ideal to have a thorough understanding of internal processes such as registration, insurance verification and proper code capture for the services offered. Following is a guideline to help ensure a smooth transition to a new provider.
In 2008, the Affordable Care Act launched a series of sweeping system-wide reforms that have had a major impact on the healthcare industry. One major development has been the progressive shift from a fee-for-service system to a value-based care system. With the previous fee-for-service orientation, hospital revenue depended on the number of services offered to patients. In the new value-based services approach, medical professionals are reimbursed according to improvements in patients’ conditions. The rationale behind this transformation is to compel doctors and hospitals to cut back on unnecessary tests. These cutbacks are intended to decrease the costs that patients have to pay and simultaneously enhance the quality of the care that they receive.
1. Minimize the need for collections by asking patients for their payments upfront.Create a checklist for your staff to follow with regard to procedures for copying insurance cards, verifying patients’ data, collecting payments, and confirming contact information. Your staff members may know the basics, but are they consistently performing them? Consistency is key. Alternatively, make the necessary arrangements for patients to be able to pay later. Focus on the start of the physician/patient encounter because that is the time when it is easiest to collect out-of-pocket payments.
Because of the availability of high-deductible plans, patients have become responsible for paying more of their bills than ever before. Unfortunately, it is more difficult to collect from patients than from governmental or private insurance companies. Therefore, it is imperative that you maximize your ability to collect out-of-pocket expenses. By collecting payment before services are rendered, you may be able to forego billing, collections, and possibly even bad debt write-offs.
Gaps in revenue cycle management present a significant financial risk for all hospitals. Among rural hospitals which tend to have fewer resources, however, the financial risk is even greater. The problem has been further complicated by constantly shifting insurance regulations and skyrocketing patient deductibles.