Against the backdrop of evolving technology and ever-changing insurance requirements, 2016 evokes hope as well as apprehensions for healthcare providers. A lot has changed in the past few months. While healthcare costs maintained a languid pace in the beginning of the year, new provisions and mandates have bridged the gap between insurance providers and the uninsured. For instance, the provisions of The Affordable Care Act resulted in 20 million people gaining health insurance coverage since the time the law was enforced. Needless to say, small changes in health insurance are having a huge impact on the revenue cycle.
A rising concern for most patients is the out-of-pocket expenses incurred. The ebbing insurance premium has undoubtedly brought health insurance within the reach of most consumers. There are employer plans to ease the medical bills and government plans such as Medicare, Medicaid and Obamacare are playing a pivotal role in alleviating health costs. And yet, the rate of growth continues to be dismal. The $2.9 trillion healthcare industry that makes up for virtually 17.4 percent of the economy owes this slump to hefty deductibles and co-payments.
A PwC study suggests that:
- The number of hospital admissions has fallen considerably since 2003 and people are avoiding hospital stays.
- Ambulatory care units and clinic visits seem like the more viable options and there is a greater reliance on generic drugs.
Costs in Healthcare and Revenue Cycle
Obamacare has been a huge help in bringing about a slowdown in healthcare costs though the fate of health insurance largely hinges on premium costs and deductibles. In such a challenging scenario, it’s important that you have proper software systems in place. The revenue cycle begins the very minute a patient walks into your clinic and it is important that you adhere to the protocol to maintain it.
Without the right processes and procedures, your revenue cycle is at risk. Revenue loss may happen due to various reasons like a painfully slow collection process, wrong documentation, or inexcusable billing errors.
Health Insurance Sign-ups
The 2016 open-enrollment period prompted 12.7 million consumers to sign up for health insurance. As opposed to the 2015 record of 8.84 million Americans signing up for a health plan or renewing their earlier plan in the 37 HealthCare.gov states, the number has risen to 9.63 million in 38 states. Going by the recent numbers, it’s safe to conclude that enrollments have witnessed a precipitous rise in 2016 as compared to the previous year.
As pointed out earlier, out-of-pocket costs are posing a greater challenge. That’s exactly the reason why healthcare organizations are reconsidering their prices to entice cost-conscious consumers. This could be a huge step in boosting the revenue cycle in the wake of high-deductible health plans. Also, master price lists are being tweaked to facilitate better negotiations with insurers.
Denial Management
Yet another important factor that can have a huge impact on the revenue cycle is denial management. The right denial management programs can also help reduce AR (Accounts Receivable) considerably. The AR milieu in recent times is dominated by issues pertaining to denials. Having a good denial management program in place can help overturn a denial way earlier.
The right denial management programs help organizations complete claim denials in the shortest time. Understanding why a patient’s claim was denied is critical in maximizing collections revenue and preventing future claims from happening. Not all patients understand the way insurance denials work. Hospitals therefore are employing advanced tools and technologies to help patients and also keep tabs on denials.
The key is to work around the three main areas namely; prevention, review, and trend tracking. While prevention strategies focus mainly on the prevention of the very occurrence of denials, review ensures that a proper analysis is done to set up a follow-up process. Tracking trends is crucial for the long-term efficiency of any denial management program since it monitors the payment patterns and notifies if there is even a slight deviation from the normal trend.
Small changes can go a long way in maximizing the healthcare revenue cycle efficiency. As such, the inherent purpose of every denial management program should be to track an error before it travels through the revenue cycle.