What Healthcare Revenue Cycle Management Services Are There?
The primary function of every medical practice is to provide care to its patients. However, every healthcare organization also has a critical secondary function—staying financially healthy. If you’re considering outsourcing your healthcare revenue cycle management, it’s important to educate yourself on the different types of services that are available and how they could apply to your practice to satisfy your financial needs.
Digital Patient Engagement: How it Affects Revenue Cycle Management
As the healthcare industry continues its shift toward outcome-driven care and value-based payments, practice-payer collaboration is key to revenue cycle success. But with so many payment-related and regulatory concerns to account for – from PQRS reporting and incentive program requirements to weighing the benefits of joining an ACO – it’s important for every provider to ensure that patient satisfaction remains a top priority.
Thankfully, however, the continuing digital transition across the healthcare ecosystem presents myriad opportunities for doctors and medical practice managers to better engage patients. And it’s important for providers to embrace the digital engagement opportunity: With more choice and transparency available to them, more and more individuals are feeling empowered to take control of their personal health… and if they’re not fully satisfied, that can often include switching doctors.
In the new landscape of healthcare and medical billing, digital patient engagement impacts on medical practice revenue in three key ways: Choice, convenience, and care.
Is Mobile Texting a Do or a Don't in the Healthcare Environment?
From employees texting bosses to business owners texting customers, many of the unwritten rules and tentative boundaries that once defined who, and what, accounted for “appropriate” texting behavior have largely fallen away. Overall, that’s a welcome development for most folks who find the convenience, clarity, and quickness of texting preferable to voice-to-voice conversation.
But the healthcare system is a somewhat different story. Mobile texting’s rise in the world of hospitals, medical offices, and medical billing companies has been shakier than in many other industries, thanks to valid, worthwhile concerns over patient privacy and the sensitive nature of healthcare information at large.
Even if your healthcare establishment has a highly limited relationship with texting (i.e., it’s “frowned upon,” or only used for patient reminders and alerts), it’s worth revisiting what is, and isn’t, ok when it comes to texting among doctors, patients, and staff. Keep the following tips in mind whenever you unlock your smartphone to ping someone in your medical practice’s orbit.
Patients or Payers – Which Come First at Your Practice?
A high-functioning medical establishment – like any other business – should ideally operate like a well-oiled machine. Your office policies should be clearly defined, your staff should be trained to follow them, and your employees should be motivated to execute their responsibilities in line with expectations.
And nowhere should those expectations be more clearly defined than when it comes to dealing with insurers. Ever-changing and illogical as they sometimes may be, payers have nothing but medical billing rules. Working with payers successfully requires your practice to adhere to rigid guidelines, so making sure your staff knows, understands, and follows those guidelines is vital to your bottom line.
Maintaining and enforcing office-wide policies about payers’ is undoubtedly a huge part of your HR program. But what happens when payer rules collide with patient care?
ICD-10-Produced Problems: How to Manage the Ongoing Impact
After all of the industry-wide infighting and regulatory postponements that marked the years leading up to the mandated shift – at long last – to exclusive use of the ICD-10 code set, the implementation phase has finally passed. And despite the extensive bickering and delays, the switch ultimately went by with less of a bang than a whimper.
How individual healthcare-sector stakeholders feel about ICD-10 depends, naturally, on their role and personal experience with the shift. But overall, results are fairly positive: 79 percent of responding organizations to a KPMG survey reported a successful ICD-10 transition since October 1, 2015.
But medical billing professionals may not be entirely out of the ICD-10 weeds just yet. (And we’re not talking about those in the 11 percent of organizations that told KPMG their transition was a “failure.”)
“Organizations are beginning to see dips in cash flow due to payers delaying the processing of ICD-10 claims while they ensure their ability to appropriately adjudicate these claims,” says Craig Greenberg, KPMG director. “Others are seeing an increase in claim denials over pre-ICD-10 levels.”
Others predict the impact on organizations’ revenue is yet to come, believing that the specificity in the data provided by the new code set will lead insurers to lower the prices they pay based on the severity of the diagnosis code.
Either way, hospitals and medical practices are wise to stay alert to potential ICD-10-produced problems. Here are our tips for staying on top of the new code set’s ongoing impact.
Is Medicare Going Broke? 3 Trends to Watch
When President Johnson signed Medicare into law on June 30, 1965, he said: "If it has a few defects, I am confident those can be quickly remedied." Quickly is a relative term… but more than fifty years later, more than a few defects remain.
The death knell and possibility for Medicare going broke and its sister program, Medicaid, has been sounded regularly for decades by politicians, government entities, and special interest groups alike. Their claims that Medicare is headed for bankruptcy are largely overblown, but they’re not entirely without merit: Healthcare spending overall has decreased in recent years, but in 2014 Medicare spent over $613 billion to cover care for 54 million beneficiaries. Projections of Medicare costs are highly uncertain, especially when looking out more than several decades, so it’s likely that the program will continue to eat up an ever greater portion of the federal budget and the economy.
Even more concerning may be the structural flaws leading the program to misallocate and misuse funds. A recent Government Accountability Office report found that $60 billion (10 percent of Medicare's budget) was lost to waste, fraud, abuse or improper payments in 2014.
Beyond that misspent 10 percent, however, what’s plaguing the Medicare program moving forward? What forces will have the greatest impact on Medicare’s solvency in 2016 and beyond? For any healthcare group, revenue cycle management entity, medical billing company, or Medicare-covered patient interested in the future of the program, these are the top issues to keep an eye on.
Open enrollment is Upon Us. How Should You Handle It With Patients?
Open enrollment is upon us once again. How can two simple words create so much complexity?
Every November-December, medical practices, insurance companies, patients, and medical billing services face down healthcare’s least favorite season - and every year it seems to get more challenging for all parties involved. Just how challenging? In a recent survey of 400 adults who purchase their own health insurance, ConnectedHealth found that more than half of those polled felt choosing a health plan was more complicated than solving Rubik’s Cube.
Depending on their employer coverage or familiarity with the Affordable Care Act and the state and national healthcare exchanges, your patients may see your practice as their only resource for navigating the complexity of open enrollment. But given that patients and providers have far different financial concerns, that’s a tricky spot for practices to find themselves in. What should, and shouldn’t, you say?
The key to assisting your patient base through the open enrollment rigmarole (without compromising your ethics) is to stick to providing fact-driven information, and to stop short of telling patients which plans to pick. Here’s what we suggest:
Fee-for-Service / Private-Pay: Physicians Grapple With Changing Models
From low reimbursements to high deductibles to non-paying patients, doctors and medical practice managers have plenty to be frustrated about when it comes to the business of healthcare. Yet interestingly, their chief complaint has little do with earning less money than they deserve – it has to do with the trouble they go to in order to get it.
Vendor Allies: The Partners Who Help You Optimize Payment Performance
Amid dwindling reimbursements, ICD-10 challenges, and the rise of high-deductible health plans, medical practices are increasingly pulling away from payers. Some are switching to concierge care, others are testing the waters with self-pay patients and rate-card pricing, but almost all physicians and medical practice managers are expressing frustration at the changing healthcare landscape.
The challenges of working with insurers are well-documented, and many of the practices trying new approaches to payment are doing so with success. But what’s a practice to do if it’s not interested in changing its model? Cutting payers out of the revenue cycle is a non-starter for many traditional medical practices and healthcare groups – especially those with small or aging patient populations.
How do you optimize revenue without making a major change to the structure of your medical practice? By leveraging the power of vendor allies.
How to Keep High-Deductible Health Plans from Hurting Your Revenue
Since the passage and implementation of the Affordable Care Act, the rise of high-deductible health plans has shown no sign of stopping. As patients increasingly purchase low-cost, high-deductible coverage from their national or state healthcare exchanges, practices have had to face the issue head on – deciding up front which plans to accept, which to turn away, and how to handle the overall impact on patient relations.
The bright side: 17 million more Americans are insured now than were pre-ACA, meaning your potential patient base is larger than ever. But due to the higher costs they face, high-deductible patients are far less likely than employer-covered ones to actually pursue care, follow through on treatment plans, and return for follow-up visits.
As such, it’s vital for your practice to take a proactive approach to patient awareness and education in order to seize your share of the newly-covered-patient market without hurting your income. Here are some of our recommendations as a medical billing company to help you embrace the high-deductible reality.