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.
Let’s talk about the financial health of your practice. First, though, let’s talk about smart health care.
According to Deloitte’s 2018 Global Health Care Outlook Report: The Evolution of Smart Health Care, smart health care requires “the correct individuals do the correct work.” The report cites the top issue in health care today as: “creating a positive margin in an uncertain and changing health economy.”
So, what does that mean for your practice?
Providers don’t go into health care because they want to manage time-consuming administrative tasks. Nor do they want to unravel the financial mysteries of achieving the highest margins in today’s world of health care value over volume. That’s why, amid evolving delivery models and complex government regulations, it’s important to find partners who do that work for you.
Freeing up provider time to focus on delivering the optimal patient experience means engaging the right experts to take on administrative burdens. But choosing the right solutions partner can be as complicated as navigating an evolving health care marketplace. Fortunately, it can also be a positive game-changer for you, your patients and the financial health of your business.
Here’s a checklist of considerations to help guide your search.
1. Consider Your Comprehensive Requirements.
The first step in the selection process is to assess your requirements: You should identify high-priority needs and the features and services that will meet those needs.
Comprehensive solutions and broader expertise from a single technology vendor make good sense if your needs extend beyond just billing software, for example. Significant cost and administrative efficiencies come when technology solutions are integrated, and partner expertise is broad. Streamlining efficiencies and reducing administrative costs through a holistic approach to technology solutions, such as integrated revenue management and practice optimization, not only improve the quality of life for physicians but also the overall health care experience.
2. Quality First.
Trust is paramount.Ask for references from prospective technology partners, understand and assess not only expertise but depth of experience. What do their current engagements involve and are they prepared to address wide-ranging challenges?
Consider the importance of working with experts who not only bring technology know-how, but also practical, first-hand health care expertise. This will mean high standards in the areas of security and patient-provider confidentiality.
3. Think Outside Out-of-the-Box.
Out-of-the-box, single platform solutions often won’t meet the specific needs of your practice. Maximized profitability often requires a variety of customizable solutions and services.
Your practice may benefit from a partner that is not only an expert advisor, but also acts as your workflow and compliance gatekeeper, delivering insights to address the unique challenges of your practice. Does the nature of your practice require technology-enabled solutions that fully integrate with your existing software systems to assist in addressing unique business challenges? Then there is significant advantage to a technology solutions provider that is system-agnostic and will deliver a customized approach that out-of-box software can’t.
Engaging the best technology solutions partner for your organization is more than a matter of healthy business efficiencies. For organizations operating in today’s complex health care economy, smart choices can be a lifeline. So, take the time to choose wisely.