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.

Healthcare billing service companies provide vital services to the medical industry; both hospitals and physician groups need their critical services. However, these billing service companies often experience their own operational pains in the form of ever-changing governmental regulations that make medical billing confusing and complicated. Other reimbursement mandates and collection regulations exacerbate the problems medical billing companies face.

This is a first in a series blogs that we believe presents an excellent strategic approach for achieving every healthcare provider’s end-goal during the transition to ICD-10 -- ensuring there is NO reduction or stoppage of their revenue stream. Our mission is to see a stronger U.S. healthcare delivery system come out of this momentous transition.

There is an upside to this second delay for ICD-10; we should use this time wisely! There will now be NO excuse for not being prepared in October 2015. This additional window of time presents an opportunity for U.S. healthcare providers to spend this period preparing for the significant impact that ICD-10 will bring. Many healthcare facilities were dreading the October 2014 implementation date; however, there is now time to prepare for the monumental changes this sweeping reform will precipitate.

In a recent Modern Healthcare article, long-time IT editor, Joseph Conn, predicted a “rocky” ICD-10 roll-out according to a survey conducted by the magazine. Even though the majority of respondents were optimistic, chaos is the predicted descriptor of the Oct. 1 deadline for nationwide conversion to the ICD-10 codes, according to the survey.

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.

The good news about the Affordable Care Act (ACA) is that more patients should have insurance coverage and seek care from physicians. The bad news is that some practices may need to turn away patients due to the fact that they are "closed" to new patients or patients will have long waits for initial appointments. The Medscape Multispecialty e-Newsletter recently offered some good advice to physicians who may be swamped with these new patients -- who will have very high deductible insurance plans. They suggest physicians:

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.

In our initial blog on big data, we posed the question: “Is big data a big boondoggle or a big solution?” Based upon our experience of helping literally thousands of healthcare providers use vast amounts of financial and clinical data to improve their revenue cycles and care delivery – we believe that big data can provide big answers. What exactly is big data? A report delivered to the U.S. Congress in August 2012 by the TechAmerica Foundation defines big data as: large volumes of high velocity, complex, and variable data that require advanced techniques and technologies to enable the capture, storage, distribution, management, and analysis of the information.

Big data is the hot buzz word right now in healthcare IT. The constant news barrage about the value of big data and business analytics/intelligence (BI) is forcing healthcare IT departments to take notice and determine what value big data really has for their facility. As this terminology has evolved in healthcare, big data has become the popular term to describe the exponential growth and availability of all kinds of data -- both structured and unstructured. What is the potential importance of big data to healthcare providers?