Used to be that when it came to compensation, healthcare providers could rest pretty easy, knowing they could count on payers — private and public — to provide the overwhelming majority of their revenue. Sure, there were the usual coding and billing challenges, and the wrestling matches over denials, but patients were mostly spectators when it came to financial transactions.
Not anymore. As high-deductible plans become more and more prevalent, providers are finding it increasingly difficult to collect what they’ve earned.
Plans that force consumers to dig deeper and deeper into their own pockets have skyrocketed in the last few years, notes Doug Vanderslice, chief financial officer and senior vice president at Boston Children’s Hospital. Consider: In fiscal 2016, Boston Children’s Hospital reported $65.2 million in unpaid collectibles. That number was 68% higher than the previous year’s, and a full 100% increase from 2012.
It’s not an isolated problem. According to TransUnion Healthcare, 68% of patients with bills of $500 or less didn’t pay off their full balances during 2016. That’s up from 53% in 2015 and 49% in 2014. Worse yet, TransUnion projects that by 2020, 95% of patients won’t pay their bills in full.
It’s an unsustainable trend for hospitals and other providers. But the ever-increasing number of high-deductible plans shows no signs of abating.
And that’s not the only revenue-management issue facing providers. The mandated shift from fee-for-service to value-based reimbursement models continues to gain steam, and with it a shifting landscape in which providers increasingly will be paid based on quality metrics and patient outcomes, regardless of the volume of care they provide.
The need to eliminate costly unnecessary care will in turn place a premium on practice management, efficiency and communication between patients and providers.
As new challenges continue to mount, how can providers large and small improve revenue cycle management? Experts suggest several areas to focus on:
- Make it as easy as possible for patients to pay. First, make expectations clear from the get-go. If possible, consider contacting patients before appointments or procedures to confirm how much they’ll owe and when they’ll be expected to pay. You may even be able to take payments over the phone. How about keeping patients’ credit cards on file? A Navicure survey found that 78% of patients are comfortable with the idea, but only 20% of providers offer such an option. For patients who find it extremely difficult to pay their entire bills upfront, try to work out payment plans and financing options, suggests Bird Blitch, chair of the Healthcare Information and Management Systems Society (HIMSS) Revenue Cycle Improvement Task Force. A little bit at a time is a lot better than nothing at all. An online payment portal is yet another option.
- Eliminate front- and back-end silos. When the patient-facing front-end staff and the back-end coding and billing staff are completely segmented, knowledge gaps are perpetuated and claim processing becomes less efficient, says Rebecca Wright, chief operating officer at Illinois’ Iroquois Memorial Hospital. Her hospital, she says, increased point-of-service patient collections by 300% by, among other things, having billers, centralized schedulers, and registration staff teach their colleagues about their jobs. For example, registration staff learned how important it was to understand eligibility and select the right insurance company before entering it into the system, since mistakes were bound to result in denials and long delays.
- Track key performance indicators. Sandra Wolfskill, director of healthcare finance policy and revenue cycle MAP at the Healthcare Financial Management Association, recommends tracking net days in accounts receivable, cash collection as a percentage of net patient services revenue, claim denial rate, final denial write-off as a percentage of net patient service revenue, and cost to collect. Those indicators reveal whether staff are accurately and efficiently performing their assigned tasks, she says, and let you “see very quickly if the trend line is going in the right direction.” If things are going in the wrong direction, she adds, consider how to better manage your workforce and resources.
- Automate prior authorizations and eligibility. Providers are facing more and more demands for prior authorizations, according to a Medical Group Management Association survey: 86% said requirements increased in 2017, while only 3% said they’d decreased. Along with being a hassle, they can be an unnecessary expense. But electronic authorizations reduce the time per transaction from 20 minutes to 6, and the cost from $7.50 to $1.89, says the Council for Affordable Quality Healthcare.
- Have a dedicated care coordinator. A care coordinator can help manage the transition to value-based reimbursements by keeping up to date with legislation and policy changes, serving as a liaison between patients and providers, encouraging patients to be compliant and responsible, and by organizing health and wellness clinics. Those efforts can lead to better health outcomes and higher reimbursements.