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Leveraging IT to Optimize Revenue Cycle Management

September 29, 2017
by Heather Landi
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A recent survey found that more than half (56 percent) of Americans are delaying payment on medical bills, citing high-deductible health plans and confusion over insurance coverage as the primary reasons. The survey, conducted by Omaha, Neb.-based communications solutions provider West Corporation, also revealed that providers are finding it more difficult to collect payments and reduce bad debt, adding to the financial stress healthcare organizations experience as they attempt to optimize reimbursements and increase revenue, while adapting to new value-based payment models.

In the West survey of 1,000 consumers, 93 percent of patients said healthcare is too expensive and two thirds (67 percent) of patients said their financial situation makes it difficult to pay their medical bills on time. In addition, three-fourths of patients say that cost and high insurance deductibles impact how often they visit their provider. In a second West survey of 236 healthcare providers, 93 percent of provider respondents said they recognize that patients may delay bill payments because of their financial situation.

The West Insights and Impact Study also found, through an analysis of the cost of insurance policies purchased through the Healthcare Marketplace during the 2017 open enrollment period, that the average annual deductible was $8,232 for a family policy, a three percent increase from 2016. Another survey conducted by the Federal Reserve released in May found that 44 percent of Americans cannot cover an unexpected $400 emergency expense without borrowing or selling something.

Patients’ rising concerns about the cost of healthcare, and the trend of delayed payments, has a financial impact on providers who are finding it more difficult to drive timely payments, grow revenue and maximize reimbursements.

“What this survey data is showing us is that patients have strong feelings about the financial aspects about healthcare right now, and that is translating into challenges for healthcare organizations and providers in terms of managing their revenue cycle,” Allison Hart, West’s chief healthcare market research and insights strategist, who led the West survey study, says.

Value-based payment programs that financially reward patient care organizations based on performance are growing in numbers. The Centers for Medicare and Medicaid Services (CMS) has already attested that it has succeeded in tying 30 percent of Medicare provider payments to value, and it is continuing to advance alternative payments as it drives toward the goal of tying 50 percent of payments to value by the end of 2018. The introduction of these new payment programs is forcing healthcare providers and organizations to seek out solutions that will enable them to maximize reimbursements, Hart says.

And yet, at the same time, providers may be missing out on opportunities to leverage existing resources, such as technology-enabled communications, to solve revenue cycle challenges, Hart says,

The West survey found that only 23 percent of providers make it a habit to always discuss each patient’s ability to afford healthcare prior to delivering services, and only 41 percent of providers currently use their appointment reminder technology to prompt patients to pay bills. Hart notes that providers should leverage automated appointment reminder notifications that they are already sending in advance of scheduled appointments to inform patients of potential copayments and out-of-pocket costs. What’s more, providers should automate payment reminder messages following appointments, she says.

“Many providers are not aware that technology-enabled communications platforms have the power to support them in a very simple way that doesn’t require them to add additional staff or resources and can help to fill in those gaps in communication,” Hart says.

Optimizing Financial Performance in the New Healthcare

Physician practices of all sizes are finding that automating RCM and claims management functions can have a significant impact on workflow, efficiency and the bottom line.

Last year, Ninth Street Internal Medical Associates (NSIMA), a Philadelphia-based primary care practice, implemented a complete overhaul of its manual RCM process, and now has a highly-automated claims management and reporting workflow that integrates with multiple systems, including the electronic health record (EHR) system. NSIMA is one of the first physician practices in the country to become certified as a Level 3 patient-centered medical home by the National Committee for Quality Assurance, according to Chauntae Joyner, billing manager at NSIMA. The practice has grown over the years to add new providers and services but hadn’t updated its RCM to meet higher patient volume. What’s more, the slower, manual claims management process meant revenue was being left on the table, Joyner says.

Working with Navicure, a medical claims management solutions provider, the practice set its sights on optimizing efficiency for claims submissions and denial, and rejection workflow through automation and integration. Denials and rejections have benefited from automation, in particular, as staff can track claims denials in real time and receive automated notifications.

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