Revenue cycle management of healthcare system involves patients, healthcare providers, medical billing companies, and insurance companies. Several reports highlight that just as the previous years, 2018 too will see diverse changes in the healthcare revenue process. Looking at the revenue cycle trends for this year, insurance verification services stays at the top. According to Leonard Wenyon, vice president of revenue cycle management solutions at IKS Health, focusing on insurance verification would help providers to improve patient payments this year.
While the front-end staff collects information from patients, confirm insurance coverage and eligibility, and register new patients, back-end revenue cycle management includes claims management, denials management, medical billing, and final patient financial responsibility collection. Providers can remind and train their front office staff to verify insurance plans and benefit levels for all current patients. Let them understand that verifications should include copay, coinsurance and deductible requirements. By verifying benefits before the patient’s appointment, the staff will help ensure patients are prepared to pay upfront costs because they’ve been informed of financial obligations in advance.
Other three key revenue cycle management trends for this year include:
Mergers & acquisitions
The year 2017 witnessed several healthcare mergers. For instance, the U.S. drugstore chain operator CVS Health Corp has signed a definitive merger agreement in December 2017 to acquire U.S. health insurer Aetna for $69 billion. This largest corporate acquisition is expected to tackle soaring healthcare spending through lower-cost medical services in pharmacies. Another case of acquisition would be that of Advisory Board that finalizes to sell its healthcare division at a $1.3B deal with United Health’s Optum.
The RevCycle Intelligence reports that such merger trends are also likely to continue in 2018 as healthcare organizations adopt additional value-based care models and transition to risk-based arrangements. When two companies decide to combine, it is likely that both of them have made great efforts to ensure their revenue cycles are supplemented with the right technology. Such mergers have now become a promising way for healthcare firms to achieve scale and boost their revenue cycle.
Medicare voluntary alternative payment models
In 2017, the Centers for Medicare and Medicaid Services (CMS) made significant changes to its approach to value-based reimbursement transition. Last year, CMS cancelled or scaled back on mandatory bundled models for joint replacement, hip fractures and cardiac care, but promised to release new voluntary models. This shift to voluntary models has been considered as a way to improve provider and payer collaboration on new alternative payment models. Providers can also enjoy flexibility with choosing the most appropriate models for their patient populations and organization.
As promised, the agency’s Innovation Center recently launched a new voluntary bundled payment model called Bundled Payments for Care Improvement Initiative (BPCI). This alternative payment model starts on October 1, 2018 and runs through December 31,2023. BPCI will qualify as an advanced alternative payment model under the quality payment program for MACRA. According to CMS administrator Seema Verma, this is an important step in the move away from fee-for-service and towards paying for value.
Patient financial experience and affordability
Patient financial experience is directly linked to profitability. As patients become increasingly empowered to make healthcare decisions and are educating themselves more about their healthcare choices, they take on greater financial responsibility for their care and increasingly seek price transparency.
According to a whitepaper published by Accenture, if patients know the costs of the medical service they seek, the majority (60 percent) choose to proceed via their provider. Affordability is also an issue. The report highlights that:
- Many providers still don’t offer the price transparency that 91% of healthcare consumers seek
- 46% of consumers said knowing their out-of-pocket price estimate is important to plan/budget for medical expenses.
- 61 percent of uninsured patients are concerned about affordability.
Giving patients the price transparency they want promotes responsible consumer healthcare planning, builds trust and loyalty. It’s also more important than ever to make care affordable.
Improving automation through their patient management systems, providing more self-service capabilities and even robotic automation can help practices reduce overall costs. Certain comprehensive strategies along with AR management solutions can also assist hospitals in minimizing reimbursement issues and accelerate cash flow.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.