GeBBS Healthcare Blog

Facing lower reimbursements and shrinking margins, hospitals are exploring ways to capture more revenue. This has led an increasing number of hospitals across the nation to outsource their revenue cycle management to professional outsourcing companies. This trend was identified in a recent Black Book™ survey, which included responses from 1,309 hospital CFOs and business office leaders. The surveyed revealed that 39.8 percent of U.S. hospitals outsourced their complex claims and revenue cycle management to specialized vendors. That is up from 20.4 percent of hospitals in 2013.

In their May 6, 2016 newsletter, the AMA stated that: “Patient care is the top priority and a source of passion for physicians, but making sure the business side of your practice is ‘healthy’ also can contribute to better outcomes and patient satisfaction.”

We couldn’t agree more!

A large Chicago-based health system recently posted an operating loss of about $186 million in 2015, nearly 15 times the amount reported in the previous year. In addition, the system will lay off 250 employees and leave 450 jobs unfilled. The health system has told its bondholders that it will write off $53 million of its accounts receivable for patient bills that went uncollected, according to a major Chicago newspaper. The CEO has attributed almost half of the system's financial losses to an inadequate collections system, which forced the hospital to write off some bills for being too old to collect.

This did not have to happen!

The Obama administration and health insurers took steps recently to standardize and improve the measures that are intended to gauge the quality of healthcare. The CMS and trade group America's Health Insurance Plans (AHIP) have announced an agreement to adopt a core set of quality measures for the nation's doctors. Officials say the measures are necessary as payers and consumers bear more responsibility for finding and purchasing high-quality care and providers are increasingly paid under contracts tied to their quality performance. This is a good move!

The climb to conquer Mount ICD-10 is going to get steeper and more difficult. Be sure you have an experienced guide to help you on this perilous journey. The ICD-10 transition difficulties were lessened by CMS by not dropping all of the thousands of new codes on the healthcare industry at one time. That is going to change.

By Nitin Thakor, GeBBS President & CEO

The HHS Office for Civil Rights (OCR) recently imposed heavy monetary fines and acceptance of resolution agreements and corrective action plans on two provider organizations following substantial violations of the HIPAA privacy and security rules.

About 30 organizations to date have now agreed to such sanctions after OCR determined they were essentially ignoring HIPAA.

In today’s healthcare delivery environment, physicians are constantly looking for new ways to earn and increase their bottom lines. For example, the 2015 Medicare Physician Fee Schedule (PFS) will pay for non-face-to-face services for CPT code 99490 -- Chronic Care Management (CCM), which reimburses practices on an average of $42 per patient, per month. Of all the governmental mandates that have come along -- this is a good one. It incentivizes physicians to extend their care management and care coordination services to their patients who need it the most, and it will improve outcomes for critically-ill patients.

Outsourced medical coding's traditional approach has been staff augmentation. It has been typically used to meet short-term gap needs due to turnover, extended absences, or electronic medical record (EMR) changes. In other words, it has been used when a healthcare provider needed temporary additional resources to supplement its existing resources. However, from our experience, this traditional staff augmentation model is not keeping up with the rapidly changing needs in the healthcare industry.

Since the inception of the term “big data,” how to handle this data has been a challenge for healthcare providers. Big data has been around since computers were first harnessed to help the healthcare industry. The challenge has always been how to handle and make sense of this copious amount of information. In 2016, big data will continue to grow. Healthcare providers will have to develop an infrastructure, or scale up through outsourcing, the capabilities to use this big data to their best advantage. You can expect an increase in the use of relationship algorithms that formulate inferences, allowing decisions to be made in real-time.

By Nitin Thakor, GeBBS President & CEO

The U.S. does have a physician shortage today and that shortage is expected to grow to over 130,000 by 2025. What is causing the problem? In my opinion two things are driving this shortfall of doctors. First, millions of new patients are and will be entering the healthcare delivery system under the Affordable Care Act (ACA). One of the main tenets of ACA -- and it is not a bad thing -- is its focus on the prevention of developing medical problems, not treating medical conditions; this takes significant time and resources.