Physician practices are facing confusion and frustration due to the shift to value-based care and the ever-rising cost of care. Physicians seeking to stabilize their revenue amidst this chaos typically find themselves facing several challenges.
1. Collecting patient payments:
Enrollment in high-deductible health plans is growing rapidly, leaving patients responsible for a larger portion of their healthcare bill.
When it comes to paying their balances due, patients expect the same consumer-grade experiences and conveniences they are accustomed to in other industries, where they can get same-day deliveries of their groceries or even purchase a car online. They also want greater price transparency.
Provider organizations, of course, are scrambling to meet these demands. They know that practices that can’t keep up with new patient demands are putting themselves at risk of losing revenue and eventually, patients, now that comparison shopping for healthcare services is on the rise.
Providing a range of electronic payment options—including online patient portals, automated payment plans and keeping a credit card on file—are all proven methods for improving the speed of payments, increasing payment processing efficiency and decreasing the cost of collections. Simultaneously, offering cost estimates at the time of a patient’s office visit can improve patients’ understanding of their responsibility as well as provide greater clarity around the cost of care.
2. Effectively tracking claims:
Managing claims across a diverse set of payers and keeping on top of coding and compliance guidelines taxes even the most efficient revenue cycle teams today. They face a host of daily questions and challenges, such as: Are patients eligible for the services? What’s the status of a claim at any given time? How quickly can they process denials and appeals? Why can’t all claims be submitted electronically?
Ultimately, the key to claims management success requires the ability to collect more from payers quickly and with less cost and effort. Many practices use a claims clearinghouse to help manage this process and to provide dashboards with up-to-the minute claims information and can help reduce denials and days in accounts receivable while improving collections.
3. Combating the lack of training for staff and patients:
Revenue cycles’ rising complexity and the shift toward value-based care make it harder for healthcare organizations to provide staff members the training necessary to succeed. As a result, employees are left to figure things out on their own. More and more, front-office staff is being called upon to help educate patients as to their responsibility and collect balances due, which requires advanced training in customer service, conflict management and collections processes.
Patients, too, may be unaware of crucial information related to their care, such as their financial responsibility versus their insurance provider’s, the total cost of their care or how to use the tools their provider has available to make it easy for them to pay their bills.
The good news? Tackling training may be the easiest, fastest and least expensive improvement you can offer. Start by ensuring each team member understands how every aspect of the revenue cycle organization fits together, and get staff members working with well-explained processes and common goals.
From there, making sure teams receive training appropriate for their current role—and the role they aspire to next—will keep employees in the know and on the job.
For patients, it’s important to inform them of their financial responsibility as early as possible, preferably at pre-service. This helps give them time to plan accordingly. Make them aware of their payment options, including automated payment plans, and note their preferred method of payment. Show them how to use your digital payment tools.
4. Start with the right tools and processes:
While much of today’s revenue cycle chaos can be tamed through automating processes to ensure a steady revenue stream, technology is only part of the answer. It also takes regular, thorough training that includes both front-office and back-office staff.
Perhaps most importantly, it requires an ongoing commitment to understanding what patients want and need, and then finding effective ways to meet those demands.
While these solutions won’t change the fact that our industry is facing some very interesting roads ahead, they certainly will help make your patients’ experience with your organization more satisfying—and will help you strengthen your bottom line.
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