It’s 2018, and the business of healthcare has never been more complicated. But that’s about to change. And not for the better.
With rising deductibles and tighter payer reimbursements, 2019 promises to be even more challenging for providers working to deliver positive health care experiences while improving the bottom line. Managing the money tied to patient encounters at each step of the process is complex. That’s why, in today’s health care economy, revenue cycle management (RCM) is crucial. Getting it right is essential to the financial viability of any health care organization.
In 2019 and beyond, when patients are increasingly paying more of their health care expenses out-of-pocket and insurers are requiring more data, how can practices improve their RCM?
The answer is an approach that includes a combination of: improvements to internal processes; deployment of sophisticated, customized technology tools; and strategic partners with the right expertise.
Let’s take a closer look at why RCM is increasingly tripping up providers and how to right the ship in the year ahead.
Trending toward More Challenges, Not Fewer
Consumer trends such as high-deductible plans are resulting in a shift in payment obligations. These plans mean patients are faced with paying a greater portion of their healthcare expenses out-of-pocket. As patients see out-of-pocket costs rise, they are facing more difficulty paying, or paying on time. For providers, that translates into greater challenges recovering payment from patients.
Moving from a fee-for-service to value-based approach also presents RCM challenges as providers face navigating through ever-changing insurer compliance requirements. This means time- and resource-intensive processes require the highest levels of quality to assure reimbursement.
With these constant changes and soaring complexity, internal staff’s dwindling time hinders the practices’ ability to recover maximum reimbursement. These challenges, combined with more physician burnout and lack of internal expertise, keep providers from focusing on RCM and the changes necessary to improve it. The result: money is left on the table. And usually a lot.
For already over-burdened physicians and staff trying to manage revenue cycles, mistakes are made when decisions are driven by limited or no data. For most health care organizations, the only available data comes from practice management systems, which aren’t comprehensive enough to be of real value.
It’s essential for practices to have sufficient data and a clear understanding of what it means. Lack of granular insights makes it nearly impossible to make effective strategic decisions to effectively manage and ultimately drive revenue.
Many billing cycle problems can be resolved before the patient ever receives care. This is where an expert can provide value developing, training staff on, and executing pre-visit procedural best practices such as registering patients, entering demographic information, verifying and scheduling appointments, and clearly explaining payment policies and procedures.
Improved billing and collections—from claims submission to final reimbursement—must be examined and optimized. Usually this happens most efficiently with a trusted strategic partner that brings deep knowledge of modern health care practice realities, as well as technology expertise and tools.
Bringing It All Together
Patient and insurer trends, data, technology and back-end processes factor heavily into a practice’s RCM success. When protocols and processes are not thoughtfully considered and implemented, a ripple effect can significantly delay reimbursements, lower margins and negatively impact the bottom line. Identifying and addressing the challenges is no longer an options but a requirement for health care organizations to thrive now and into the future.