Although for most of us, the grass is always greener on the other side of the mountain, at times it is not so for some. This is especially true for office managers in the healthcare industry. It might seem as though the sky is falling over their head; such are the challenges and concerns that confront the healthcare facilities. But then at the end of the day, futile fretting over the problems would do no good and hence it is better to confront them head on.
Let us analyze few of the top most concerns of an office manager in any clinic or healthcare facility.
1. Information about health insurance policy - A healthcare facility predominantly faces challenges because of low reimbursement. This is observed more in cases of any employer-sponsored commercial or corporate insurance plans. This is because of slack in proper communication and educating the person taking up insurance. At times, such reimbursement rates cover just 85-95% of costs. The bigger challenge is making the patients sign up for such an exchange and a healthcare facility has to ensure that sufficient awareness is created to make sure that the patient base has been insured appropriately. And the third of such challenges is bearing through the after effects of high-deductible plans.
These also spell a big chance for healthcare facilities to lower their bad debt under the exchanges as a majority of bad debt arises from uninsured patients. If high-cost patients are covered by the exchanges, healthcare facilities can reduce one of the most expensive categories. All of these issues, especially the one regarding the medical billing of costs for the healthcare facility have to be addressed and looked into by an office manager, which comes across as quite a challenge for them. Revenue management on behalf of the healthcare facility is thereby one of the key functions of the office manager.
2. Implementation of ICD-10 - ICD-10, which is set to be implemented on October 01, 2015 may bring good news for a few healthcare facilities, while for those who haven’t paid heed to it, will have to bear the brunt, especially with regards to the medical billing services. While some practices have been diligently preparing to greet the new change, others are not even close to implementing them. The reason why some providers are ill prepared to meet the change is lack of time.
It is for the office manager to see that all are trained as per the new systems, made acquainted with the new terminology and coding standards in case healthcare facilities are willing to embrace the new coding standard.
3. Increasing scope of the organization - For an office manager, healthcare reforms have broadened the purview of a healthcare facility and introduced issues like conflicting external pressure, navigating their priorities, and so on. One way to overcome this is, reforming the strategic plans, deciding the kind projects the healthcare facility handle with their current capacity and resources.
4. Mission sustainability - For an office manager in a clinic, this challenge varies from institution to institution, but for most of them evaluating their market position is the determining factor for surviving reimbursement cuts. This is especially true in case of non-profit organizations. Different scenarios and effects of healthcare reforms are making these professionals decide if their healthcare facility will be able to live up to its goal.
5. Price transparency - The Charge Description Master (CDM) / charge-master / charge master, which is a complete description of items billable to a patient or a patient’s health insurance provider was revised in 2013. This charge-master data of healthcare facilities came as a shock to many office managers as there was a huge distinction between charge-master prices (also known as sticker prices) and the amount the facility would actually get. As consumers become more careful about how they spend, attention to healthcare charges is not likely to decrease in 2014 as well and the ambulatory surgery, diagnostics, imaging, and pharmacy are likely to come under the scanner for prices charged. Although it undoubtedly seems that the road ahead is a bumpy one, healthcare facilities and office managers in particular have a lot to gain from these challenges if they know how to turn the deal in their favor by exploring different avenues for return.