GeBBS Healthcare Blog

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.

In an earlier blog, we admonished healthcare providers not to let their revenue cycles be swamped by the rising number of new self-pay patients entering the healthcare delivery stream. Under the Affordable Care Act (ACA), the self-pay portion of a healthcare provider’s receivables is going to increase significantly. According to a recent Healthcare Financial Management Association (HFMA) study, the current self-pay average is 20 percent of a healthcare provider’s receivables, but that is only going to increase over the next few years. How to manage the accounts of patients who must pay a significant percentage of their bill out of pocket will be a key strategy to achieve or maintain profitability during the new rollout of federal reform mandates.

Hospital Revenue Cycle Management is about to be challenged by an unintended consequence of the Affordable Care Act (ACA). Even as hospitals are set to see an influx of newly insured patients, industry watchers warn that bad debt may become an even larger problem under theACA, putting more pressure on already thin margins.

The effects of weak revenue cycle management can go well beyond just financial challenges. Revenue problems can also lead to patient dissatisfaction challenges, and this can lead to reimbursement problems. Why do so many hospitals experience problems with their revenue cycle? A good explanation is that busy healthcare providers are challenged to keep abreast with the rapidly changing and complex payer requirements for pre-authorizations, medical necessity checking, new coding mandates, accurate charge capture, reporting requirements and a plethora of other financial challenges. This is compounded by the rise in self-pay patients and the inefficient data that supports the collection of these accounts. In general, many providers just don’t have the time to efficiently and effectively monitor their revenue cycle across the enterprise.

For physicians, getting paid properly for the services they provide is extremely important. Between constantly changing coding rules and dozens of insurance contracts -- each with its own coverage, billing and payment terms -- many medical practices find it difficult to keep up. As a result, physicians too often are paid less than they actually should be which impacts their cash flow.

When you are one of the largest medical billing services companies in the Southwest U.S. and your mission is to help other physician groups solve their staffing and financial challenges, how do you react when you are faced with these very same issues?

Outsourcing Solution Saves Healthcare Provider from Smothering under Acquired Accounts Receivable (A/R) Avalanche

Today’s healthcare professionals, who are responsible for revenue cycle management, must feel like fire fighters who while fighting the main blaze must deal with smaller fires that keep breaking out all around them. The challenge these healthcare professionals face is how to ensure all present billing gets accomplished and collected, while working on legacy A/R accounts that have fallen seriously behind. These legacy accounts often contain large amounts of revenue that need to be collected.

A Professional Business Process Outsourcing (BPO) Partnership Can Help You To Be Prepared for Natural Disasters like Hurricane Sandy.

No one could have predicted the magnitude of the recent devastation wreaked by Hurricane Sandy across the eastern part of our nation. CNN reports that "at least 81 people in the United States and two in Canada have died as a result of Sandy, raising the storm's overall death toll to 150. It earlier claimed 67 lives in the Caribbean. But the struggle toward normalcy ramped up Thursday, as authorities in nine states tallied worked to restore basic services like public transit and electricity.  About 4.9 million customers across the eastern United States were still in the dark early Thursday, down from the nearly 8 million who lost power shortly after the storm hit".

The healthcare revenue cycle management (RCM) is just beginning to feel the effects of consumerism as employers focus on containing healthcare costs. This means that today’s growing financial pressures on healthcare organizations will continue to escalate as consumers bear an increased financial responsibility for their healthcare costs.

Hospitals are under pressure to collect various streams of revenue — due to lower Medicare, Medicaid and commercial payor reimbursements — in order to stay solvent, maintain a requisite cash flow and keep revenue figures stable. Credit rating agencies and a hospitals' own internal financial management teams know that cash is king right now, and the revenue cycle teams have to overcome the contemporary obstacles to keep a steady cash and revenue flow.