GeBBS Healthcare RCM Blog

Transforming the Business of Healthcare

Posted on Fri, Jun 15, 2018 @ 02:09 PM

The overall theme of this year’s HFMA Annual Conference is “Transforming the Business of Healthcare,” and it is right on target. No other industry is experiencing more evolution and transformational change than healthcare. It seems that the only thing we can count on is change -- this is even more true for the business side of healthcare delivery.

Managing change is all about handling the complexity of the process. It is about evaluating, planning and implementing operations, tactics and strategies. It is never a choice between technological or people-oriented solutions, but a combination of both. This is certainly true when it comes to revenue cycle management (RCM).

This period of transformation is precisely the time to engage with a partner who brings a deep understanding of revenue cycle management to the table. GeBBS Healthcare Solutions provides tailored revenue cycle management solutions that cut through the complexity with expertise, operational excellence, and a sophisticated approach. We deliver solutions specific to the clients’ needs and work with their legacy systems, using their tools. GeBBS builds efficient workflow processes with higher output through the use of hybrid solutions that employ both automated technology and the expertise of qualified people.

Serving thousands of hospitals and healthcare organizations nationwide, GeBBS provides end-to-end, comprehensive revenue cycle management solutions from payer credentialing to complete billing and collections services. With many years of RCM experience, our billing experts are well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. We follow industry-standard key performance metrics to measure success and integrate best practices, so that you get the value of our proven experience and expertise. Our comprehensive range of revenue cycle management solutions, include:

  • Accounts Receivable (A/R) Management -- Lack of skilled resources can lead to a backlog of claims that need to be processed. It is critical to success to have access to a large pool of qualified resources that can work with your organization and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.
  • Credit balance resolution -- HFMA calls credit balances the “stealth aircraft of hospital patient accounting.” GeBBS maintains a team specialized in credit balances resolution. Our team is comprised of highly-qualified individuals with hospital accounting backgrounds and strong analytical skills.
  • Denial management – The key to success in denial management is having access to a large pool of qualified denial management resources that can work with healthcare organizations and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover lost revenue.
  • Extended business office-- GeBBS offers comprehensive extended business office (data entry) solutions that take the worry out of the RCM process by improving your efficiency and collections while reducing costs.

Let us help you transform your business side of healthcare delivery. With GeBBS as your partner, there is no reason to fear change – we can help you embrace it and make change work for you!

The Importance of Eligibility Verification and Pre-authorization

Posted on Thu, May 31, 2018 @ 10:30 AM

In medical billing terminology, eligibility verification, pre-authorization, prior authorization and pre-certification are terms that may be used interchangeably to mean that for certain situations and procedures, providers have to contact insurers in advance and obtain a certification number in order to be reimbursed properly (or at all) for services. Insurance verification and insurance authorization services play a vital role in revenue cycle management. In fact, most claim denials happen when a patient is ineligible for services billed by the provider.

Depending on what the patient's coverage documents and the provider's contract with the insurer specifies, neglecting to obtain pre-authorization can result in reduced reimbursements or lower benefits for the patient. If a provider neglects to obtain pre-authorization and payment is denied by the insurer, it may come down to absorbing the cost of the treatment or trying to collect it directly from the patient.

GeBBS Healthcare Solutions, with our Eligibility Verification and Pre-Authorization services, specializes in next generation revenue cycle management to help increase cash flow and speed medical billing processes.

With today’s high-deductible insurance policies, insurance and eligibility verification are absolutely critical. Identifying patient responsibility upfront, prior to the visit, is critical to managing the receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment.

A McKinsey Quarterly survey of retail healthcare consumers showed that 52 percent of consumers would pay from $200 to $500 or more by credit or debit card when they visit a physician, if an estimate was provided at the point of care.

To avoid these problems, GeBBS provides a remotely-hosted Centralized Eligibility Unit for hospitals, faculty practice plans, PMS/EMR vendors, and billing companies. The solution consists of GeBBS staff, technology, management and expertise that delivers high-quality, cost-effective patient insurance eligibility and related services.

GeBBS Eligibility Verification/Pre-authorization Services can:

  • Improve A/R cycles (reduce A/R days)
  • Increase cash collections by reducing write-offs and denials
  • Receive schedules from the hospital via EDI, email or fax
  • Verify coverage on all primary and secondary (if applicable) payers by utilizing sites like WebMD, payer web sites, interactive voice response systems, and phone calls to payers
  • Contact patients to get updated insurance information
  • Provide the clients with the results, which include eligibility and benefits information such as member ID, group ID, coverage end and start dates, co-pay information
  • Obtain pre-authorization number
  • Obtain referral from PCP
  • Enter/update patient demographics
  • Remind patient of POS collection requirements
  • Inform client if there is an issue with coverage or authorization
  • Process Medicaid enrollment

 

The Age of Revenue Cycle Management Outsourcing Has Arrived

Posted on Thu, May 17, 2018 @ 02:13 PM

The RevCycle Intelligence e-newsletter reported recently that 80 percent of hospitals are vetting full revenue cycle management (RCM) outsourcing. The demand to outsource full RCM is up 86 percent from 2015 among hospitals and inpatient organizations. Approximately 80 percent of hospital leaders in a new Black Book survey of 709 C-suite executives, board members, and senior managers at hospitals and other inpatient organizations said they were vetting or considering outsourcing full RCM by 2019.

The survey revealed the demand for RCM outsourcing is significantly up because hospitals and inpatient organizations are looking to reduce costs and focus on value-based care initiatives. Nine out of ten hospitals are also considering partnering with a third-party vendor to allow hospital leaders and providers to prioritize value-based care implementation.

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The complexity of value-based care reforms and their impact on revenue have put pressure on hospitals to decrease inpatient volumes, achieve financial outcome goals and provide cost-effective care. RCM outsourcing is growing because it offers struggling hospitals immediate results.

This is precisely the time to engage with a partner who brings a deep understanding of the revenue cycle. GeBBS Healthcare Solutions provides tailored revenue cycle management solutions that cut through the complexity with technology, service capability and operational excellence.

GeBBS provides a broad portfolio of HIM and RCM solutions to thousands of physician and healthcare organizations nationwide. As hospitals and physician practices look for ways to contain costs and increase their revenue, RCM outsourcing is a valid strategy to achieve a financially healthier organization. It’s just a matter of finding the right partner with the right expertise and technology.

Revenue Cycle Management Is More Than Just Managing Your Cash Flow

Posted on Tue, May 01, 2018 @ 07:43 AM

Many healthcare providers are under the impression they can assess their financial health by evaluating cash flow only. However, cash flow is just one factor in revenue cycle management (RCM). To maintain a healthy revenue stream, healthcare providers need to understand the other important metrics that should be calculated and reviewed when evaluating their revenue cycle.

The American Academy of Family Practice (AAFP) association has identified five key metrics in RCM that are critical to maintaining a healthy revenue stream:

  • Days in Accounts Receivable
  • Days in Accounts Receivable Greater Than 120 Days
  • Adjusted Collection Rate
  • Cost to collect – your total billing expenses as a percentage of revenue.
  • Denial Rate
  • Average Reimbursement Rate

GeBBS provides end-to-end, comprehensive revenue cycle management solutions for all of these metrics, including, complete billing and collections services. With 12+ years of RCM experience, our billing experts are well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. We follow industry-standard key performance metrics to measure success and integrate best practices, so that you get the value of our proven experience and expertise.

Our Solution includes:

  • PMS/EMR System and RCM Process Implementation
  • Scheduling, Eligibility Verification, and Pre-Authorization
  • Medical Coding
  • Claims Submission (Use your clearinghouse or partner with ours)
  • Accounts Receivable (A/R) Management
  • Credit Balance Resolution
  • Customer/Patient Access Solutions

Our A/R Management solution provides a large pool of qualified resources that can work in any practice management system and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R. GeBBS analysts can trend denials and look for patterns of deficiency that will increase cash flow and reduce aging A/R.

As a partner to our clients, GeBBS serves as a direct RCM extension to hospitals and physician practices by leveraging our healthcare expertise, technology and qualified resources to offer comprehensive extended business office (data entry) solutions that take the worry out of the RCM process by improving your efficiency and collections while reducing costs. With improved first-pass rate, a 97% accuracy level, and guaranteed turnaround times, you can focus on growing your business and keeping your patients

healthy. GeBBS end-to-end RCM provides a complete solution to help you maintain a healthy revenue stream.

Rising Costs in Healthcare Lead to Increased Demand for Outsourced Solutions

Posted on Thu, Apr 05, 2018 @ 09:00 AM

Healthcare IT News reported recently that nearly three-quarters (73 percent) of health systems with more than 300 beds -- and 81 percent of providers with fewer than 300 beds -- are shifting their focus to IT outsourcing for development and complex infrastructure services. Their data was based on Black Book Research that surveyed 1,030 hospital CIOs and IT leaders and 243 CFOs and financial executives from 266 hospitals and the business managers from 1,400 outpatient, alternative care and physician practices for their insights on technology and outsourcing services options.

The Black Book study’s overwhelming conclusion was that immediate access to a fully-trained staff and its technology, in combination with a positive return-on-investment, are the driving forces behind the turn toward IT outsourcing, especially as the demand on healthcare organizations grow in complexity.

Doug Brown, managing partner of Black Book, said, “Our research found that most hospital leaders see no choice but to evaluate and leverage next-generation information and financial systems as an outsourced service in order to keep their organizations solvent and advancing technologically."

GeBBS Healthcare Solutions provides a comprehensive suite of outsourced revenue cycle management (RCM) and health information management (HIM) solutions. Our in-depth healthcare industry expertise enables us to provide end-to-end solutions to successfully resolve our clients’ billing challenges, while embracing their overall business operations.

GeBBS delivers a world-class infrastructure of highly skilled professionals, robust processes, and proprietary workflow engines. This makes us an ideal outsourcing partner for our clients. By leveraging our people, processes and technology, we enable clients to reduce operating and capital costs, recover revenue, improve patient satisfaction, and increase productivity. With a current staff of over 5,000+ professionals, GeBBS is one of the nation’s fastest growing companies, as recognized by Inc. 5000.

Walmart Reportedly in Early-stage Talks to Buy Humana

Posted on Mon, Apr 02, 2018 @ 02:00 PM

Here we go again! In my last blog I mentioned how companies like Amazon, Google, Apple, Uber, etc. will be driving innovations in healthcare delivery and costs over the next 10 years. Today, the Wall Street Journal (WSJ) reported that retail giant Walmart is in preliminary talks with health insurer Humana about developing a closer partnership, with one possibility being that Walmart might acquire Humana.

If you are a Humana customer right now, they strongly suggest that you use Walmart for your prescription coverage. If this deal comes to fruition it will have a significant effect on the healthcare industry and it could be good for consumers/patients, since Walmart seems committed to its “always the lowest price strategy.

Here are five interesting facts that the WSJ reported:

1. The two companies are discussing a variety of options, and it is not certain they will strike a deal. If they do reach an agreement, it would be Walmart's largest deal ever. Humana's current market value is about $37 billion.

2. If the potential deal, which would require regulatory and shareholder approval, closes, Walmart would be one of the largest health insurers in the country.

3. The talks between Walmart and Humana come amid a flurry of deals that could transform the business of managing healthcare, including CVS Health's proposed acquisition of Aetna for $69 billion and Cigna's proposed acquisition of Express Scripts for $54 billion.

4. Humana shares jumped 10 percent in after-hours trading March 29 after WSJ reported the preliminary talks. Shares of Walmart dropped 1 percent.

5. Walmart, which is a major drugstore operator in addition to being the world's largest retailer and has a current market value of $260 billion.

America’s largest companies continue “to think outside the box,” and they have their eye on the healthcare industry.

Finally, we are thinking out of the box..

Posted on Tue, Mar 06, 2018 @ 10:36 AM

Companies like Amazon, Google, Apple, Uber, etc. will be driving innovations in healthcare delivery and costs over the next 10 years. This will have a significant, positive effect on the industry and it will be good for consumers/patients.

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One of the major social determinants in population health management is how to get patients to their care delivery sites. Uber in a big grab for the medical transit market announced the launch of a new digital tool meant to book rides for patients who need assistance getting to and from their appointments. A healthcare provider can book a ride for patients and caregivers immediately, within a few hours, or with 30 days’ notice. The company is positioning itself as a cheaper and more reliable option than most non-emergency medical transportation. Their announcement included over 100 healthcare providers all across the US.

Amazon is also trying to disrupt healthcare. They made big news last month after announcing it would seek ways to address soaring healthcare costs for its own employees. The online shopping titan is focusing its industry-disrupting power on the broader healthcare sector.

The retailer has rolled out a line of private label over-the-counter medicines and is building a business selling a wide array of medical supplies to doctors, dentists and hospitals. Amazon says the efforts are part of its strategy to enhance the shopping experience for businesses and consumers. The company’s efforts in the healthcare field are being closely watched, especially after it announced last month that it is working with Berkshire Hathaway and JPMorgan Chase to better control costs and reduce spending on the health insurance they offer for the 840,000 people who work for them.

Some industry watchers also speculate that the firm may try its hand at selling prescription drugs in the near future, though they warn this would be a big lift since the drug industry is so highly regulated.

Apple has also joined the fray by launching medical clinics to deliver the “world's best healthcare experience” to its employees. The company is launching a group of health clinics called AC Wellness for its employees and their families this spring, according to healthcare industry sources familiar with the company's plans.

The company quietly published a website, acwellness.com, with more details about its initiative and a careers page listing jobs including primary care doctor, exercise coach and care navigator, as well as a phlebotomist to administer lab tests on-site. Apple’s new primary care group — a group of clinical staff that is run independently from Apple but is dedicated to Apple employees — will initially only serve Apple's employees in Santa Clara County, where its headquarters are located. Initially, it has two clinics in the county.

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The Importance of Capturing Charges and Posting Payments Correctly and Efficiently

Posted on Thu, Feb 15, 2018 @ 07:20 AM

With patient volumes on the rise, these increased number of transactions, in the face of limited resources, mean backlogs, data entry errors, and increased days in A/R. Now is the time to get expert help for your overworked staff.

GeBBS offers comprehensive extended business office (data entry) solutions that take the worry out of the process by improving your efficiency and collections while reducing costs. With improved first-pass rate, a 97% accuracy level, and guaranteed turnaround times, you can focus on growing your business and keeping your patients healthy. This is accomplished with a combination of advanced technology resources along with qualified and knowledgeable billing professionals.

Patient collections are on the rise with many newly insured participants in Affordable Care coverage. High-deductible plans are putting added pressure on revenue cycle operations and the drive to collect patient payments. Having access to a large pool of qualified resources to process payments timely, correctly and provide full-service bank-to-book reconciliation, which are critical to your operations.

GeBBS has experience in working with all the leading EHR systems, including but not limited to Cerner, Epic, McKesson, NextGen, Allscripts, MEDITECH GE Healthcare, eClinicalWorks, and athenahealth.

Our expert data capture services are driven by iP2P (Intelligent Paper to Payment), our proprietary workflow application engine. This solution automates the receipt, processing and posting of all RCM paper documents including charges, demographics, insurance payments, patient payments and correspondence. The iP2P® comprehensive Business Process Management tool can handle all your charge entry and payment posting outsourcing.

The iP2P workflow engine streamlines the outsourcing process by automating the receipt and processing of all paper documents. The client portal provides real-time visibility into production, exception management, and auditing. The index module gives you access to all charges and explanation of benefits (EOBs) from the web portal.

The iP2P Client Portal provides full visibility into real-time production status, exception management and auditing, along with an image repository for easy retrieval and viewing of the scanned documents.

When charge capture and payment posting are done well, the benefits to your practice are obvious —improved cash flow is probably the most important. You can also expect better overall collections when billing problems are spotted early and addressed promptly, secondary payers are billed accurately, and patients receive prompt and accurate statements. Efficient charge capture and payment posting are a win-win for your practice.

Efforts Applauded, But Uphill Battle Unlikely to Produce Results

Posted on Mon, Jan 22, 2018 @ 09:30 AM

Four not-for-profit health systems recently unveiled plans to create their own generic drug company. Industry experts say they'll face an uphill battle to make a significant dent in one of the fastest-growing industry expenses and persistent problems: rising drug prices and drug shortages.

Modern Healthcare magazine reported last week that Intermountain Healthcare, Ascension, SSM Health and Trinity Health are working with the U.S. Department of Veterans Affairs to pool their capital and 450 total hospitals to fight back against drug companies that unexpectedly hike the prices of decades-old off-patent generic drugs with minimal competition. They also look to create a more reliable supply of generic drugs like saline and sodium bicarbonate that are vulnerable to shortages.

While the health systems didn't specify what drugs their new venture will make, they want to provide both sterile injectables and oral medication either through their own FDA-approved manufacturing facility or by contracting with existing manufacturers. Most hospitals have some compounding pharmacy capacity, but the initiative will not use hospital compounding facilities to produce products, Harrison said.

Industry experts have commented that while they applaud the effort and think it might be a step in the right direction, this endeavor is going to be a labor-intensive and costly to set up manufacturing efforts.

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Players across the health industry have discussed how to cope with dramatic price hikes of widely used drugs coupled with enduring drug shortages, but solutions have been harder to come by. Retail prescription drug expenses accounted for about 12% of total U.S. healthcare spending in 2015, up from about 7% through the 1990s, according to a recent report from the U.S. Government Accountability Office. Branded drugs with no generic alternatives, or single-source drugs, are the main culprit. A study from Blue Cross and Blue Shield Association found that patent-protected drugs make up 63% of total drug spending. This new endeavor cannot combat 63 % of total drug spending.

But even off-patent drugs are part of the drug price dilemma. Valeant Pharmaceuticals, for example, acquired the rights to the off-patent heart drugs nitroprusside and isoproterenol and increased their respective prices 30-fold and 70-fold over a three-year span. The Cleveland Clinic found that utilization across 47 hospitals it studied decreased utilization by 53% and 35% for nitroprusside and isoproterenol respectively, which took a toll on patient safety and outcomes.

The health systems are making a valiant effort, but it is very unlikely that their work will significantly affect the cost of drugs or any drug shortages.

Medicare Advantage Growth Could Spell Problems for Providers

Posted on Thu, Jan 18, 2018 @ 07:41 AM

Medicare Advantage (MA) business continues to experience significant growth, increasing demand for MA plans. Despite the uncertainty surrounding health care and proposed budget cuts to the program, Medicare Advantage enrollment continues to climb and this trend is expected to continue throughout 2017 and beyond. As of February 1, 2017, total Medicare Advantage membership stood at 19,593,341, with a net gain of 1,389,665 members, year-over-year.

According to data from the Centers for Medicare and Medicaid Services (CMS), 34% of the 58 million people eligible for Medicare are enrolled in MA plans across the United States and U.S. territories. The top ten carriers covered over 68% of all Medicare Advantage enrollees as of February 1, 2017. UnitedHealth Group and Humana lead the segment with more than 4.6 and 3.3 million MA members, respectively. Aetna and Kaiser Family Foundation also command significant market share with each enrolling over 1.4 million.

This continued MA growth has the potential to exacerbate the problem of how to manage members within these high-deductible health plans. Research has found that offerings in high-deductible health plans (HDHPs) and related products are projected to grow by 11 percent per year. HDHPs have several pros and cons. They offer flexible spending options for healthier beneficiaries with a low-premium, high deductible financing design. However, HDHPs can be problematic for older and sicker beneficiaries.

These high-deductible plans are forcing healthcare providers to adopt new and unique revenue cycle management strategies. This trend of increasing high-deductible plans is expected to grow over the next several years. As a result, both patient liability and bad debt are on the rise and healthcare providers are experiencing unprecedented revenue and margin pressures. Hospitals and clinics have become like retail organizations, which need to provide their consumers with access to payment capabilities at point of service, via the web, through payment plans, and more. The answer for healthcare providers is to take advantage of professional outsourcing companies who have expertise in patient access management solutions that can improve patient satisfaction, while lowering their collection costs and increasing revenue. These necessary outsourcing services include:

  • Scheduling, Eligibility Verification, and Pre-Authorization
  • Patient Call Center
  • Self-pay Collections

Self-pay collection is the most critical of these services. A recent McKinsey study found that 74 percent of insured consumers indicated that they are both able and willing to pay their out-of-pocket medical expenses. An experienced outsourced self-pay collections team leverages analytics to arrive at the best time to contact patients and their propensity to pay scores to create outbound campaigns that are patient experience-oriented, non-obtrusive, and drive higher patient connect ratios.

Don’t let high-deductible, self-pay insurance amounts wreck your revenue cycle. Work with an experienced outsourcing team that will provide your patients with flexible payment options and easy access to payment capabilities for web, phone, credit card, and e-check payments.