GeBBS Healthcare Blog

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

Healthcare Financial Professionals Seek New Ways to Rescue Revenue Cycle Management

Posted on Mon, Oct 06, 2014 @ 10:29 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 forcing 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), Accountable Care Organizations (ACOs), Affordable Care Act, Insurance Billing Solutions

3 Reasons You Don’t Need To Outsource Your Revenue Cycle Management Processes

Posted on Tue, Nov 19, 2013 @ 02:25 PM

As a healthcare provider, you do not need to outsource any of your revenue cycle management activities, provided that the following are all true:

1.  All of your revenue cycle activities are completely efficient, productive and up-to-date!

2. You are totally certain that your facility will not be hit by declining revenues and negative profitability due to the transition to ICD-10.

3. You are confident that your RCM technology and processes will enable you to accommodate upcoming regulatory requirements updates, such as participation in accountable care organizations (ACOs).

However, if you are not confident of these three activities then your business is at financial risk, and you should consider working with an experienced and knowledgeable outsource partner.

In a recent survey by Black Book, a technology and services market research and opinion company, 87 percent of the medical practices surveyed, reported that their billing and collection systems were inefficient and needed upgrading. If you fall into that blessed 13 percent category where everything is just hunky-dory, you are all set to go.

If you fall into the 71 percent of physician practices – reported in the same survey -- who ARE experiencing financial hardships, you may want to consider outsourcing some or all of your RCM activities. What can you expect by outsourcing your RCM?

The largest benefit will come in the form of immediate resolution to the majority of your RCM challenges. Outsourcing your RCM can provide a wide range of services that leverage experienced people, processes and technology to provide immediate operational and financial solutions that will maximize your reimbursements and reduce expenses.  These services include: 

 Eligibility & Benefit Verification    

 In the absence of proper eligibility and benefit verification, countless downstream problems are created -- delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment. To avoid these problems, an outside expert service can be employed to remotely host a centralized eligibility unit for medical practices. This solution can deliver an expert staff and technology management with the objective of delivering high-quality, cost-effective patient insurance eligibility and related services.    

 Medical Coding

High quality coding services are essential to the survival of a medical practice, especially with the upcoming transition to ICD-10. A team of experienced Certified Professional Coders, who are ICD-10 trained, and professionally accredited, will have the proficiency to meet any medical practices coding and billing needs.

Charge Capture and Payment Posting Services

This solution should automate the receipt, processing and posting of all RCM paper documents including charges, demographics, insurance payments, patient payments and correspondence. Services within this solution should include:

* Patient Registration

* Charge Entry 

* Payment Posting 

* Denial Posting and Management

* Account Reconciliation 

* Refund Handling

 Credit Balance Resolution    

Credit balance backlogs should be prioritized and processed. Incorrect adjustments, erroneous credits and misuse of debit codes can make the credit balance task quite challenging. A professional approach is the key to resolving credit balances, many of which become account corrections as opposed to actual refunds.

In conclusion, if everything in your practice’s revenue cycle management is “ship shape,” then you have no need for professional outsourced RCM assistance. However, if you are one of the thousands of medical practices who are struggling with daily financial hardships, you may want to consider outsourcing as a definite solution to your RCM challenges. Visit www.gebbs.com for solutions!    

 

 

Tags: Accountable Care Organizations (ACOs), Business Process Outsourcing (BPO), Revenue Cycle Management (RCM)

The Impact of Accountable Care on Your Revenue Cycle

Posted on Thu, Apr 11, 2013 @ 04:27 PM

Becoming an accountable care organization (ACO) requires that your facility adopt a completely new point of view when it comes to revenue cycle management. The goal of an ACO is to reduce costs by improving the quality of care provided to patients. Providers are encouraged to and boost preventative efforts that may ultimately reduce the future need for high-cost medical services such as hospital stays. As a reward for the collaborative efforts of the ACO, participating insurers such as Medicare will generally offer financial rewards for lowering costs and meeting quality care goals for their patients. On the down side, this also means that ACO providers are accountable to Medicare and may risk losing money if their costs run higher than expected. Costs will no longer just affect overall profitability; for example, they will be evaluated in conjunction with efficiency to determine reimbursement parameters. Healthcare organizations need to be able to collect the correct financial and quality data, compile accurate reports and run predictive analytics in order to meet ACO objectives of better care at lower costs.

Due to its many tenets, it is difficult for many healthcare organizations to fully understand the total ramifications of becoming an ACO, and how to adequately assess the risks and benefits of ACO participation to their revenue cycles. The assessment involves a careful analysis of data capture methods, revenue cycle infrastructure, and available clinical and financial analytical tools to help maximize efficiency during the transition.

One effective strategy to assess the risks and benefits of becoming an ACO is to engage an experienced RCM outsourcing partner who understands the ramifications of becoming an ACO. They can educate you on the various pro’s and con’s and assist in deciding whether or not it would be beneficial to establish an ACO or join an ACO. The decision will vary greatly among provider types, geography, local health care environment, and organizational preparedness. Those considering the ACO concept must first figure out how much risk their organization is willing and able to take.

One of the biggest misconceptions about joining an ACO is that the revenue cycle will be easier to manage. In fact, just the opposite will most likely be true. The reality is that the complexity simply shifts. Payers demand more specific data about the management and outcomes of patient populations and providers and organizations need more sophisticated cost and performance information to negotiate contracts. These cost controls are more crucial under risk-based contracts; therefore organizations need to rely more on integrated data systems and predictive analytics. Healthcare providers will require the use of  advanced analytics, measured by accurate and applicable data, to manage costs and quality of care provided to patients.

A knowledgeable RCM partner can help your organization identify and capture the critical data you need for ACO participation. Before your facility can perform a risk-benefit analysis, you must have the most effective technology to capture the correct information. Your technology must be configured correctly to capture meaningful information and workflows to support the changes expected by this new business model.

Today’s EHR systems make the discrete capture of large amounts of patient data possible. By applying the appropriate analytical tools to this discrete data, your organization can measure and monitor the costs and outcomes that directly impact compensation within the ACO. An experienced RCM partner can leverage a higher degree of analytics to ensure seamless coordination among healthcare providers and accurate attribution models. Likewise, when fully integrated with a practice or enterprise management system, organizations can pinpoint and predict how much it costs to treat certain patient populations and how resources should be utilized. It is this broad, population-based analysis that is necessary to put organizations in a better position to evaluate ACO opportunities and performance.

 

Tags: Evaluation and Management (E&M) Requirements, GeBBS Healthcare Solutions, Knowledge Process Outsourcing (KPO), Business Process Outsourcing (BPO), Accountable Care Organizations (ACOs), Healthcare Revenue Billing, Affordable Care Act, Revenue Cycle Management (RCM), Medical Coding

Top 5 Questions and Answers on Accountable Care

Posted on Wed, Oct 24, 2012 @ 11:07 PM

The federal government spends around $1 trillion a year on health care programs. Different communities — the elderly, the disabled, military and civilian federal employees, low-income individuals and their families, and others — benefit from these programs. The two largest programs are Medicare and Medicaid.

Although nearly 48.6 million Americans are uninsured (source: The Commonwealth Fund) and the cost cost of healthcare is rising, the ongoing debate about health care reform now reflects the recognition that the gaps in quality and seemingly inexorable cost increases are the result of a delivery system that is failing to fully serve the nation's needs. Part of the solution that has been proposed in the recent federal health reform bills is the concept of Accountable Care Organizations (ACOs).

national health expenditures as a share of GDP

Top 5 Question & Answers on Accountable Care & Healthcare Delivery in the United States:

1. What is Accountable Care Organizations (ACOs)?

ACO is defined as a set of healthcare providers — including primary care physicians, specialists, and hospitals — that work together collaboratively and accept collective accountability for the cost and quality of care delivered to a population of patients.

Accountable care organizations (ACOs) have proliferated in the past three years. The increase has been spurred by private payors' interest in coordinated care management and the Patient Protection and Affordable Care Act, which introduced the Medicare Shared Savings Program. There has been a significant amount of ACO development within the past years. According to the National Accountable Care Organization Congress, "since the 2nd National ACO Congress in November 2011, the ACO trend has demonstrated great momentum. As of June, there are more than 200 ACOs identified in the U.S., a 38% increase in only six months. The number and variety of organizations adopting accountable care demonstrates providers’ strong belief that the accountable care model is a crucial component of the future of American healthcare".


2. The new health reform law–The Patient Protection and Affordable Care Act–supports the evolution of accountable care organizations (ACOs) as key to containing health care costs. Do you agree with this assessment?

 

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Tweet your answer and follow @gebbshealthcare on Twitter. Why follow GeBBS on Twitter? GeBBS Healthcare Solutions is a Healthcare focused Business Process Outsourcing (BPO) company that specializes in enhancing the financial performance of our provider clients by seamlessly supporting the Revenue Cycle Management (RCM) process.

 

3. Why are Accountable Care Organizations important to achieve improved cost and quality?

Although nearly 46 million Americans are uninsured and the cost cost of healthcare is rising, the ongoing debate about health care reform now reflects the recognition that the gaps in quality and seemingly inexorable cost increases are the result of a delivery system that is failing to fully serve the nation's needs. Part of the solution that has been proposed in the recent federal health reform bills is the concept of Accountable Care Organizations.

The Affordable Care Act includes a provision that allows Medicare to reward health care organizations with a share of the savings that would result from improving care quality and reducing the cost. To participate in this “shared savings programs,” health care organizations need to become Accountable Care Organizations (ACOs).

The belief is that, if well conceived, ACOs can achieve both cost and quality improvements because the coordinated and collaborative nature of the delivery system itself is paid for and rewarded for its quality outcomes, not for its volume of services.  Therefore, the structure of an ACO becomes important—experts believe that ACOs must be physician-led, primary care-centered, and patient-focused systems of care.  Currently, there are many health care systems of physicians and hospitals that function as ACOs are intended to fucntion, and the research conducted on these entities support the prevailing notion.  By encouraging the evolution and growth of ACOs through payment incentives and a nurturing legal climate, ACOs may be America’s best chance to control costs and improve quality and access.

 

Annual Per Capita Health Care Costs

Annual Per Capita Health Care Costs resized 600

Data from the OECD. Compiled by PGPF. NOTE: Per capita health expenditures in 2009, except Japan and Australia data which are from 2008. Foreign health spending was converted into U.S. dollars using purchasing power parity.

 

4.  What is being done on the commercial side of our health care insurance system?

 

ACOs as proposed by the ACA would receive bonus payments if they are able to manage the cost and improve care quality under the Medicare fee-for-service shared savings program.
Commercial health insurers are also revealing extensive plans for ACO development. They are partnering with hospitals and physician’ groups to test new models of care delivery.  Payment by insurers and the government should incentivize cost control and the improvement of care.
Major payors like Cigna, UnitedHealth Group, Blue Cross Blue Shield and Aetna continue to pursue performance-based contracts with providers across the country.

Learn more about 80 commercial and Medicare ACOs

5. What are the real cost savings that can be anticipated by an ACO and how will they be achieved?

The Congressional Budget Office projects that the ACO shared savings program included in the Affordable Care Act will save approximately $5.3 billion over 2010–19.  This is only a small portion of the savings the CBO projects through implementation of all of the provisions of the ACA.

However, the real cost savings are unknown—both to an individual ACO and to the country as a whole.  Much will depend on the extent to which:

  • How ACOs are formed
  • How effective they are in improving quality and containing costs
  • Whether the shared savings program works as a fee-for-service incentive or if the payment model needs to be modified
  • The capabilities of ACOs of handling different expectations of different payers

 

Tags: Revenue Cycle Management (RCM), Accountable Care Organizations (ACOs), Affordable Care Act