GeBBS Healthcare RCM Blog

Kim Snow

Recent Posts

Patient Access Management: The New Vanguard in Healthcare

Posted on Thu, Nov 20, 2014 @ 03:37 PM

With all of the changes in healthcare reimbursement policies and the influx of high-deductible patients, healthcare providers need to shift their patient access management strategies to meet these new challengesNo longer can the registration process be looked upon as a simplistic completing of forms patient_billingand getting the patient into a bed. Today's patient access professional must be capable of highly skilled worksuch as reviewing referrals, obtaining authorizations, verifying eligibility, determining the patients’ willingness and ability to pay, requesting payment at time of service and arranging sophisticated payment schedules to ensure collection of revenue for services rendered.

Today’s patient access representatives have much broader responsibilities than did traditional registrars in the past. Hospital information systems use insurance plan codes to identify the various products offered by each insurance carrier. Patient representatives are expected to quickly decipher which plan the patient belongs to from the patient's ID card. The patient representative's choice affects the manner in which the claim is sent to the carrier, and an incorrect choice can delay claim submissions and often result in rejected claims and delayed payments.

Managed care agreements have added another level of complexity. Patient access representatives must know when to obtain preauthorization and referrals, and to verify the appropriateness of the place of service. Even the most sophisticated "managed care matrix" cannot address every scenario for every plan. Within a specific carrier, the rules can differ down to the level of a particular employer. 

Healthcare providers must become highly creative in implementing best practices for patient access management to address today’s patient registration challenges. 

Tags: Patient Access Management, Insurance Billing Solutions, Revenue Cycle Management (RCM)

Healthcare Consumerism and Patient Access Management

Posted on Tue, Oct 21, 2014 @ 11:59 AM

Healthcare consumerism is going to be an important factor in the new healthcare financial environment where many patients are going to be responsible for a large portion of their healthcare costs. Consumer self-service is already becoming common place in healthcare today. Access to healthcare kiosks and patient portals will become an expectation in patients’ healthcare delivery processes. Allowing healthcare consumers to research costs, schedule appointments, receive online statements and make electronic payments are just some of the options consumers are demanding.

The healthcare revenue cycle is just beginning to feel the effects of this consumerism as employers focus on containing healthcare costs. Revenue cycle solutions that extend the capabilities of a healthcare organization’s hospital information system are the key to improving access management, responding to healthcare consumerism, accelerating cash collection and improving payer performance.

Patient Access Management

The expanding role of patient access professionals in the revenue cycle is the next step in responding to healthcare consumerism. In the future, these professional will become the “face” of many healthcare providers to the general public. Patient access representatives, used early in the healthcare delivery process, can help providers not only determine insurance eligibility, but also the consumers’ ability and willingness to pay for their healthcare costs. Including medical necessity checking during registration, scheduling and ordering can also help reduce Medicare denials and increase reimbursement by providing medically necessary services or by issuing an ABN for non-covered services.

With the growing financial pressures on healthcare organizations, due to the influx of high-deductible consumer/patients, providers need to seek innovative strategies to improve their revenue cycle performance. The use of patient access management early in the revenue cycle may be a way to avoid financial disaster downstream.

Tags: Revenue Cycle Management (RCM), Revenue Cycle Management (RCM), Patient Access Management, Insurance Billing Solutions

Healthcare Financial Professionals Seek New Ways to Rescue Revenue Cycle Management

Posted on Mon, Oct 06, 2014 @ 10:59 AM

Business pressures are forcing healthcare financial managers to re-evaluate their present revenue cycle management solutions, and look to the next generation of solutions for answers to their financial woes. Shifting payment models, new regulations and healthcare reform are forcingHealthcare Financials healthcare leaders to redirect previously launched budgets, priorities and strategic plans to assess if new solutions can rescue them from imminent financial catastrophes.

Most hospital CFOs and group practice managers have no choice but to look for next generation of RCM solutions in order to keep their organizations solvent. Reimbursement challenges and coping with increased self-pay volumes have driven many marginally performing healthcare organizations to the brink.

In 2014, it is predicted that changes, such as reduced reimbursements, payment reforms, accountable care organizations (ACO), ICD-10 coding transition activities, physician practice acquisitions and increased self-pay collection costs will all contribute to overall declining margins. The increase in self-pay accounts will be significant, driven the Affordable Care Act (ACA) which is going to send a huge number of newly insured patients into the healthcare delivery system. Under ACA, every U.S. citizen is required to have some form of medical insurance, or pay an opt-out fine.

Not only will physicians and hospitals be swamped by treating this new wave of patients, their infusion into the healthcare system is going to create significant financial challenges due to many of the newly insured patients having extremely high deductible insurance plans, forcing hospitals and physician groups to collect this money on their own. According to a January 2014 article in Kaiser Health News, out-of-pocket payment amounts under the ACA will range from $6,350 for individuals to $12,700 for families.

This new pressure on healthcare providers’ revenue cycles is not going away; it’s something everyone will face soon.

Tags: ICD-10, Revenue Cycle Management (RCM), Revenue Cycle Management (RCM), Accountable Care Organizations (ACOs), Healthcare Revenue Billing, Accounts Receivable (A/R), Affordable Care Act