Multiple factors pressure healthcare revenue stream
As with any important process, the healthcare provider’s revenue cycle has a distinct beginning – in this case it is the patient’s initial encounter. And it is at this critical juncture that providers must do everything possible to ensure that all the financial details are in order.
Recovering money lost at the intake step grows more convoluted and futile as time passes, financial experts say – a consequence that has grown more serious in a challenging healthcare economic climate.
“You need to capture and bill out everything you are providing service for – trap everything you can,” says Mark Isenberg, business development manager for Indianapolis-based Zotec Partners. “Over the past three years self-pay is the largest payer with health savings accounts and high deductible plans, which are stretching out the revenue cycle and allowing for more bad debt to occur.”
Radiology groups have seen reimbursement declines in recent years and “clearly have a target on their backs from CMS’ effort to reduce multiple procedures,” Isenberg said. Zotec is working with these clients to provide electronic audits on the front end to reconcile claims throughout the system. Any anomalies are flagged.
The company has also developed an outbound dialer that reaches out to patients notifying them of any unpaid charges. “The days of statement letters are pretty much over,” Isenberg said.
Orthopaedic Specialists of the Carolinas in Winston-Salem, N.C., identified intake as the primary source of its revenue stream, especially verifying insurance eligibility, said business office manager Regina Hayes.
The 23-physician clinic has four locations and sees roughly 700 patients each day – a volume that is 23 percent higher than last year, she said. Since adopting a web-based claims clearinghouse from Duluth, Ga.-based Navicure, the organization has developed an intake system that establishes each patient’s insurance status before services are rendered.
“Patients would come in with an insurance card that may or may not be valid and even though we had one FTE dedicated to checking out eligibility, it was impossible to catch everything,” Hayes said. “Ineligibility had a huge impact because many of our patients are surgery candidates – it is imperative to pre-certify their insurance status.”
Navicure has also helped the clinic maintain a low days outstanding level for its accounts receivable, which averages about 30 days, Hayes said.
“By working in real time, we know when the claim hits the payer and helps us get ahead of rejections and denials,” she said.
Tricia Fletcher, manager of sales support for Campbell, Calif.-based SCI, says many provider organizations are still solidly “siloed” between departments, which makes revenue cycle management a disjointed, labyrinthine process.
“What I see is an environment where things are so disparate,” she said. “No one is really talking to each other without a paper chase. People have to navigate all the systems for registration, authorization and verification.”
SCI aims to solve the problem by breaking down the silos and integrating everything starting at the point of patient scheduling and integrating the workflow from there, Fletcher said. By using automated kiosks for registration, patients furnish all their necessary information to providers for processing.
“We bring everything together into one central repository,” she said. “We have communication tools to help providers flow through the process…that drives the information through the system.”
The ICD-10 factor
While healthcare providers continue to pursue every dollar in the revenue stream to which they are entitled, a major event is on the horizon that will require even more effort. The conversion of the Medicare coding format from ICD-9 to the much more complex ICD-10 in October 2013 is less than two years away and the industry needs to do more to prepare, says Kim Hollingsworth, partner with Chadds Ford, Pa.-based IMA Consulting.
“ICD-10 is the next thing that hospitals need to consider,” she said. “Even though it’s two years away, there is lots of planning and modifications that need to be made to prepare. What’s important now is to look at the impact of ICD-10 on the organization from every perspective – many things will need to be changed.”
The main thrust for preparation, Hollingsworth said, is to educate the clinical staff on how services will be impacted by the new codes, which stratify service classifications on a much wider scale. In turn, coders must be trained about the specifics of anatomy and physiology in order to comprehend these new classifications.
“The implications are critical and it goes beyond codes,” she said.
As patients take on a greater portion of their healthcare services payments, the need to present clear, legible, easy-to-read statements has taken on greater importance. To help providers create more consumer-friendly bills, Nashville, Tenn.-based Emdeon ExpressBill Services has been upgrading its printing technology.
With the assistance of Stamford, Conn.-based Pitney Bowes, Emdeon has installed new printers that use a “roll-to-roll” method of printing, which is superior to the old “cut sheet” format, said Jon Eaton, Emdeon director of manufacturing. The new method, he said, gives the statements a full variable color capability that allows providers to customize their statements.
“Adding color to patient communications not only improves readability but also draws attention to important information such as Amount and Date Due, and helps accelerate patient payments while reduce billing-related calls,” Eaton said. “Another critical concern for providers is getting the patient statement in the mail stream as quickly as possible. The speed and efficiency gains we have realized allow for faster processing that delivers our customer’s healthcare statements into the mail stream faster, thereby helping to speed their revenue stream back to them.”
Grant Miller, vice president of global strategic product management for Pitney Bowes’ Document Messaging Technologies division, added that “mailed statements provide an essential communications link between patients and practitioners” and that companies are “constantly looking for innovative ways to manage the cost of mailing statements while offering more effective ways to communicate with customers.”