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Increasingly, Physician Practices Paying Fees To Receive Electronic Payments

Posted on October 13, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Virtually no one would argue that health plan reimbursement levels are particularly high. Adding a fee if they want to get paid electronically seems like adding insult to injury, doesn’t it?

Unfortunately, one in six medical practices report being hit with these charges, according to research by the Medical Group Management Association. Its recent survey found that some practices are paying a meaningful percentage of total medical services payments to get paid via Electronic Funds Transfer (EFT).

Under rules created by the Affordable Care Act, designed to decrease healthcare administrative overhead, CMS created a standard for EFT transactions. Health plans have been required to offer EFT payments if providers request it since 2014.

Health plans’ payment policies seem to vary, however. A recent MGMA Stat poll, which generated responses from more than 900 medical practice leaders, found that while 50% of practices were not paying fees for receiving payments via EFT, others are absorbing big surcharges.

For one thing, health plans are increasingly offering practices a “virtual credit card” they can use to receive payments. While 32% of MGMA respondents said they weren’t sure whether they paid an electronic payments fee or not, other research suggests that many practices end up using virtual credit cards without knowing they would be charged 3-5% per payment received.

Meanwhile, 17% of respondents told MGMA they were definitely paying transaction fees, and of that group, almost 60% said that the health plans in question used a third-party payment vendor.

MGMA sees this as little short of highway robbery. “Some bad actors are fleecing physician groups by charging them to simply receive an electronic paycheck,” said Anders Gilberg, MGMA’s senior vice president for government affairs.

The MGMA is asking CMS to issue guidance preventing health plans and payment vendors from charging EFT-related fees. The group argues that such fees are counter to the goal of reducing healthcare administrative complexity, the stated purpose of requiring health plans to offer EFT payments.

Also, the American Hospital Association and NACHA, the electronic payments association, are asking CMS to set standards on when and how health plans can implement virtual cards, as well as making it easy for practices to move to EFT.

The imposition of fees is particularly unfair given that health plans benefit significantly from issuing EFT payments, the group says. For one thing, health insurers save millions of dollars by sending payments via EFT, MGMA notes. Not only that, sending payments via EFT allows health plans to automate the re-association of electronic payments with the Electronic Remittance Advice.

While it’s true that physician practices used to save time staff would’ve used to manually process and deposit paper checks, that doesn’t make the fees okay, the group argues. “Beyond the material administrative time savings for all sides, the time and resources that physician practices spend on billing and related tasks are better spent delivering healthcare to patients,” it said in a prepared statement.

Health System Sues Cerner Over Billing-Related Losses

Posted on October 5, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

If I asked you what issues cause the biggest conflicts between EMR vendors and their clients, you might guess that clinical data management disputes or customer service issues topped the list. But actually, in my experience the most common problems health systems encounter in their EMR rollouts are billing-related.

For example, Dana-Farber Cancer Institute just announced a $44.2 million operating loss for the third quarter of fiscal 2017. The Boston-based hospital attributes at least part of its losses to billing issues associated with its Epic system. Leaders at Dana-Farber said that these billing issues had cost the hospital roughly $25 million since it rolled out Epic in May 2015, according to Becker’s Hospital CFO Report.

Another instance comes from Healthcare IT News, which reports that Cerner is being sued by a health system accusing the vendor of selling it faulty billing software.

The suit, by Wisconsin-based Agnesian Healthcare, accuses Cerner of fraud and breach of warranty, and asserts that issues with Cerner’s revenue cycle software led to losses of more than $16 million. The hospital system contends that these problems have damaged its reputation and generated $200,000 a month in damages. (Cerner disputes these allegations, of course.)

According to HIN, the hospital system went live with Cerner’s RCM software in 2015, for which it paid $300,000. Agnesian’s suit says that problems with the Cerner package began shortly after rollout, generating widespread errors in its patient billing statements.

According to the health system, its billing process was so compromised that it had to send out statements by hand. (Yes, I can feel you cringing from here.) Given the delays inherent in relying on manual processes, Agnesian ended up with a huge backlog of unprocessed statements, some of which it deemed uncollectible and wrote off.

When the health system alerted Cerner about its concerns, the vendor got involved, and in 2016 it told Agnesian that problems have been addressed.  Nonetheless, this year the health system found “major additional coding errors” which led to another round of lost revenue, Agnesian says.

And brace yourself for more cringing: according to the suit, the Cerner RCM software had been writing off reimbursable charges without informing the health system. If you’re an RCM leader or CFO, this is the stuff of nightmares.

Ultimately, Cerner agreed that the RCM solution needed to be rebuilt given the depth of the coding errors found in the software, but that didn’t happen, the suit says. In a final indignity, the personnel tasked with rebuilding the RCM solution left Cerner before completing the rebuild.

Given all the aforementioned mishegas, it will be many a month before billing processes normalize even if Cerner fixes its RCM software, the health system says. And of course, it’s likely to end up writing off more bills under the circumstances, which has got to be very painful by this point.

Agnesian’s suit asks the court to cancel the Cerner contract and award it direct, indirect and punitive damages. Cerner, meanwhile, seems to want to go into arbitration. We’ll see which side blinks first.

Medical Groups Struggling To Collect Payments Promptly

Posted on August 18, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Particularly as patients assume responsibility for more of the costs of care, it’s getting harder for providers to collect on outstanding bills.

My recent look at a dashboard created by the Medical Group Management Association certainly underscores the point. The story it tells is a grim one. Despite their best efforts, few practices are succeeding at meeting RCM challenges.

The MGMA intends the dashboard, which focuses on the number of days bills spend in Accounts Receivable, to give medical groups some benchmark RCM data. It relies on data from the group’s 2016 DataDive Cost and Revenue study, and allows users to view (at no cost):

  • Mean percentages of accounts receivable aged 0-30 days, 31-60 days, 61-90 days, 91-120 days and over 120 days
  • Mean days gross fee-for-service charges in A/R
  • Meeting days adjusted fee-for-service charges in A/R

It also allows users to select a specialty group type, including primary care, nonsurgical, surgical and multispecialty practices and look at their specific profile.

For example, the dashboard reveals that roughly 50% of accounts held by primary care practices spent a mean of 0-30 days in A/R, 11.2% of accounts were aged 31-60 days, 6.9% were at 61-90 days, 6.2% stayed in A/R for 91-120 days and 25.4% for 120+ days in A/R.

The MGMA page also stated that primary-care groups had an overall average of 61.86 adjusted days in A/R and 35.60 gross days in A/R.

Does that sound depressing? Well, it should. What’s more, other specialties’ performance was nearly as bad in some categories and even worse in others.

Look at the performance of nonsurgical groups. Only 44.7% of nonsurgical groups’ revenue came in within 30 days in A/R or less, almost 13% of accounts averaged 31-60 days before being paid, and almost 15% of accounts spent between 61 and 120 days in A/R. Twenty-eight percent of accounts had a mean 120+ days in A/R before being satisfied.

The other stats were even worse. For example, nonsurgical groups’ accounts spent a mean of 88 days in A/R and 46.2 gross days in A/R. Not very encouraging.

Even well-paid surgeons weren’t exempt from this problem. Most of the account aging stats were distributed similarly to the other specialty areas, and only 28.2% of accounts in this area spent more than 120 days in A/R. However, adjusted days in A/R came in at 136.7 and gross days in A/R at 54.

Meanwhile, the tally for multispecialty groups was a bit better, but not much. Account aging benchmarks were very similar to primary care practices, and adjusted days in A/R came in at 69.4.

Most of you probably had an idea that medical groups were facing these kind of collection problems, even if you didn’t have these benchmark numbers in hand. The thing is, they were even worse than I feared. (An acquaintance working in medical billing called the results “comical.”)

I don’t know what percentage of the accounts in question were self-pay, but given that self-pay is becoming a steadily higher proportion of medical practice revenue, these stats are pretty bad news. Something’s gotta give eventually. Plus, we’ll have to keep tracking how this data trends over time.

Few Providers Are Covering All Bases In Patient Collection Efforts

Posted on July 27, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

If the following is any indication, providers have a pretty good idea of what they need to do if they want to collect more from patients. The thing is, many providers aren’t doing it, or least not doing enough. I find this a bit surprising, given that while putting all of them into place may be intimidating, there’s many smaller things they can do to make progress. For whatever reason, though, even the smaller things aren’t happening.

That at least, is the conclusion that leapt out at me when I looked at data from a recent survey on the subject of patient collections. I could be missing something, but it looks as though providers are blowing many opportunities to collect a higher percentage of what patients owe.

The study, which was sponsored by Navicure and conducted by HIMSS Analytics, draws on data from two groups, patients and providers, including 1,000 patients and 553 healthcare industry respondents with revenue cycle management or RCM technology knowledge.

In formulating the survey, researchers sought to compare patient attitudes about provider billing with the providers’ actual behavior.  If the results are any indication, patients are considerably more cutting-edge than providers when it comes to getting the bills paid.

One thing I took away from the survey results was that while patients seem fairly willing to adopt provider-friendly billing options, many providers aren’t accommodating them.

For example, while 52% of patients told researchers that they’d prefer electronic billing over paper statements, and 79% of patients say they are comfortable being billed via email, 89% of providers said they still send out statements via postal mail. I know rethinking billing procedures is hard and all, but making this change seems like it’s worth the effort.

Another striking example of where providers could step up is the use of “credit card on file” programs. Medical practices who seem to be getting a lot of results from CCOF programs, under which patients allow the practice to bill the card for smaller charges.

Despite patient acceptance levels, only a minority of providers said they had gotten on board with CCOF as of yet. In fact, though 78% of patients said they were comfortable with CCOF payments, only 20% of providers said that they such a program in place. That’s another big gap between patient attitudes and provider willingness to follow through.

Then there’s patient concerns about preparing for bills. Admittedly, providers are ahead of patients on this one. Seventy-five percent reported being able to provide a cost estimate, but only 25% of patients said they had requested an estimate on the last visit.

Still, consumers  are catching up with providers quickly, with 56% reporting that they expect to ask for cost of care estimates in the future. Even better, the estimates don’t have to be perfect. In fact, more than two thirds of patients said they would find either any estimate or an estimate that came in within 10% or less of their actual costs to be helpful.

Yes, getting all of these strategies into place together is clearly easier said than done. But given what’s at stake for providers, anything short of impossible is worth a try.

Reinventing Claims Management for the Value-Based Era

Posted on February 16, 2017 I Written By

Provider claims management as we once knew it is not enough to thrive in a value-based era. Here’s what you need to know about taking claims management to a higher level.

The following is a guest blog post by Carmen Deguzman Sessoms, FHFMA, AVP of Product Management at RelayAssurance Plus RelayHealth Financial.

Provider claims management as we know it can no longer exist as a silo. With the rapid transformation from fee-for-service to value-based models, denial rates remain high–nearly 1 in 5 claims–despite advances in technology and automation. The complexity of value-based payment models almost guarantees an increase in denials, simply because there’s so much to get wrong.

For provider CFOs and their organizations to be effective–and thrive–in this environment, the touchpoints across the revenue cycle continuum must be re-examined to see if there are opportunities for improvement that have not presented themselves in the fee-for-service era. One such area is claims management, which is ripe to be elevated into an integral part of a denials management strategy.

What are the implications for providers? Well, for perspective, consider the savings realized through electronic claims submission.  CAQH research reveals that submitting a claim manually costs $1.98, compared to just $0.44 per electronic transaction. Likewise, a manual claims status inquiry costs $7.20 versus $0.94 for processing electronically.

This paper outlines the features and benefits of a technology platform that is geared toward elevating traditional claims management into the realm of strategic denial prevention and management, along with some recommended denial management best practices.

From Claim Scrubbing to Strategic Denial Management

Simple claims management as we know it is becoming obsolete. By “simple” we mean a claims process with a basic set of capabilities: creating claims, making limited edits, and ensuring that procedures are medically necessary. Today, a new class of integrated claim and denials management solutions augment this traditional approach to include pre- and post-filing activities that help automate and streamline claim submission, proactively monitor status, and expedite the appeals process for those that are denied.

In its simplest form, denials management can be defined as a process that leads to cleaner submitted claims and fewer denials from payers. But there are a lot of interim steps and variables that lead to “clean” claims, and a growing number of factors that influence denials. With the shift to alternative payment models and increasing consumerism, it’s more important than ever for providers to process claims properly the first time and to keep staff intervention to a minimum.

A big part of denials management is to improve the quality of patient data at registration, the source of many errors that lead to denials. Nonetheless, integrated claim and denial management processes span the entire revenue cycle, and technology brings new opportunities to manage costs and improve efficiencies. For example, having the ability to manage claims within a unified platform that can share and integrate data with the organization’s EHR prevents the need to toggle back and forth between systems to determine the status of a patient encounter.

A comprehensive claims management platform that advances denials management efforts integrates the following capabilities:

  • Eligibility verification prior to claim submission. It sounds pretty basic, but eligibility and registration errors on claims continue to be the top reason for denials. Automating the real-time verification of eligibility data helps identify avoidable denials and alert staff to claims needing attention before submission.
  • Maintenance of and compliance with oftenchanging payer business rules and regulatory requirements, including Medicare and state-specific updates, so that claims go out as cleanly as possible on the front end. With multiple payers and a growing roster of alternative payment models, manual in-house maintenance of edits is becoming an overwhelming task.
  • Digitization of attachments for Medicare pre- and post-payment audits, commercial claims adjudication and integrity audits, and workers compensation billing support. Integrating digital data exchange into the claims management workflow can help providers better control administrative costs, ensure regulatory compliance, and help automate and streamline claims processing and reimbursement.
  • Visibility into claim status lifecycle, with guidance for proactive follow-up. This lets providers only focus on those potential “problem” claims, and address any issues, before they are denied or delayed.
  • Automation of repetitive and labor-intensive tasks such as checking payer portals or placing phone calls to determine the status of pended or denied claims. This helps drastically reduce the amount of staff time spent perusing payer sites, and sitting on the phone on hold when an answer can’t be found.
  • Predictive intelligence to determine timing of payer acknowledgements and requests for additional information, as well as when payment will be provided. Analytics-driven claims management provides insight into how long responses should take, alerting providers when follow-up is required.
  • Management of remittances from all sources. Automated management of transaction formats, adjudication information, remittance translation and posting can help reduce A/R days, boost staff productivity, and accelerate cash flow.
  • Denial management and data analysis to guide corrective action and prevent future denials. Revenue cycle analytics can monitor the number of claims per physician, payer, or facility, enabling the health system to be proactive in interventions.
  • Creation and tracking of appeals for denied claims, including pre-population and assembly of appropriate forms. This not only helps cut down on resource-intensive manual work and paper attachments, but streamlines the appeals process.

Tying these capabilities together within an exception-based workflow helps address the challenge by providing visibility into problem claims. At-a-glance access to claim status helps cut down on the back-and-forth between billing departments and payers, and allows staff to focus only on those claims that require attention.

Pulling it all Together

Once you’ve integrated these capabilities, what are some of the claims management best practices to improve denial management and prevention? Consider the following actions:

  • Embed denial management within the entire workflow–Strong edits lead to clean claims, whether they pertain to Medicare, commercial payers or state-specific regulations. Edits should be constantly refined and seamlessly implemented, and pushed out to providers as often as possible–at minimum on a twice-weekly basis.
  • Adopt analytics-driven claims management–Claims management systems and connectivity channels to payers (i.e. clearinghouse) produce a wealth of operational information, most importantly data evidencing the speed of the payment path and claim status. Analyzed and served up in meaningful formats, this data becomes targeted business intelligence that can help providers better see obstacles and identify the root cause of denials and payment slowdowns.
  • Resolve issues before they result in denials–Providers should know claims location and status at all times. For example, has the claim been released by the EHR system? Has it been received and approved by the payer—or does a problem need to be addressed? Has a problem been rectified? Has the claim been released to a clearinghouse? Historical trends establish guidelines for the timing of events (e.g., whether claim status or payment should have been received from a particular payer by a certain date).
  • Be ready to identify claims denials and submit appeals. Nationwide revenue cycle statistics show that 1 in 5 claims are denied / delayed and can be avoided with the right software and better business processes.  In addition 67% of these denied claims are recoverable Identifying denials and submitting appeals to supply information not included on the initial claim can recoup lost revenue. To help streamline the process, additional claims information, such as medical records or lab results, should be supported by structured electronic attachments rather than faxed paper records or uploaded files to payer portals.

An Ounce of Prevention = Big Returns

Reducing and managing denials will have a significant impact on any healthcare organization’s bottom line. First, it costs $25 to rework a claim, and success rates vary widely. Additionally, when denials must be written off, the drop in patient revenue may total several million dollars for a medium-sized hospital, according to Advisory Board estimates.

The new look and feel of claims management is moving quickly toward analytics-driven, exception-based processing. By implementing and leveraging these capabilities and best practices in a cloud environment, providers can look forward to accelerated cash flow, reduced denials, increased automation with less staff involvement, and lower IT overhead.

About Carmen Sessoms
With over 20 years of progressive strategic leadership and healthcare experience in product management, business development, strategic planning and consulting, Carmen Sessoms has worked with all organizational levels in the ambulatory and acute care markets for patient access and reimbursement.

Prior to joining RelayHealth, Carmen was the regional vice president of operations for an outsourcing firm, where she led the eligibility side of the business and was instrumental in many process improvements that brought efficiencies to the company, its provider customers and their patients. Additionally, she has 10 years’ previous experience with McKesson in Product Management roles in which she directed projects related to the design and development of revenue cycle solutions, including initiatives with internal and external partners.

Carmen is a past president of the Georgia HFMA chapter, a recipient of HFMA’s Medal of Honor, and holds the designations of CHFP (Certified Healthcare Financial Professional) and FHFMA (Fellow in HFMA).

Practice Management Market To Hit $17.6B Within Seven Years

Posted on February 1, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new research report has concluded that the global practice management systems market should hit $17.6 billion by 2024, fueled in part by the growth of value-adds like integration with other healthcare IT solutions.

The report, by London-based Grand View Research, includes a list of what it regards as key players in this industry. These include Henry Schein MicroMD, Allscripts Healthcare Solutions, AdvantEdge Healthcare Solutions, athenahealth, MediTouch, GE Healthcare, Practice Fusion, Greenway Medical, McKesson Corp, Accumedic Computer Systems and NextGen Healthcare.

The report argues that as PM systems are integrated with external systems EMRs, CPOE and laboratory information systems, practice management tools will increase in popularity. It says that this is happening because the complexity of medical billing and payment has grown over the last several years.

This is particularly the case in North America, where fast economic development, plus the presence of advanced research centers, hospitals, universities and medical device manufacturers keep up the flow of new product development and commercialization, researchers suggest.

In addition, researchers concluded that while PM software has accounted for the larger share of the market a couple of years ago, that’s changing. They predict that the services side of the business should grow substantially as practices demand training, support and system upgrades.

The report also says that cloud-based delivery of PM technology should grow rapidly in coming years. As Grand View reminds us, most PM systems historically have been based on-premise, but the move to cloud-based solutions is the future. This trend took off in 2015, researchers said.

This report, while worthwhile, probably doesn’t tell the whole story. Along with growing demand for PM systems,I’d contend that vendor sales strategies are playing a role here. After all, integration of PM systems with EMRs is part of a successful effort by many vendors to capture this parallel market along with their initial sale.

This may or may not be good for providers. I don’t have any information on how the various integrated practice management systems compare, but my sense is that generally, they’re a bit underpowered compared with their standalone competitors.

Grand View doesn’t take a stand on the comparative benefits of these two models, but it does concede that emerging integrated practice management systems linking EMRs, e-prescribing, patient engagement and other software with billing are actually different than standalone systems, which focus solely on scheduling, billing and administration. That does leave room to consider the possibility that the two models aren’t equal.

Meanwhile, one thing the report doesn’t – and probably can’t – address is how these systems will evolve under value-based care in the US. While appointment scheduling and administration will probably be much the same, it’s not clear to me how billing will evolve in such models. But we’ll need to wait and see on that. The question of how PM systems will work under value-based care probably won’t be critically important for a few years yet.

(Side note:  You may want to check out John’s post from a few years ago on practice management systems trends. It seems that the industry goes back and forth as to whether independent PM systems serve groups better than integrated ones.)

AMA Introduces MACRA Tools – MACRA Monday

Posted on October 10, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

The American Medical Association has released a package of online tools designed to help physicians cope with major changes to Medicare rolling out next year under MACRA. While it’s likely that practices will still have plenty of challenges to address on their own, these tools seem like they may offer a leg up on the subject, particularly for smaller practices with less resources to throw at MACRA issues.

One of the tools being introduced is the AMA Payment Model Evaluator (Sadly an account is required, but there’s an option to create a new account), designed to help doctors determine how their practices will be impacted by MACRA. The Evaluator, which was developed in partnership with physicians and AMA partners, asks physicians and medical practice administrators to fill out an online questionnaire on their practice. The Evaluator then offers an assessment of their specific situation, along with educational material and other resources. This includes recommendations on which MACRA payment model is best for them, which can help your practice know the best direction for your specific needs.

The AMA has also added new MACRA-specific tools to its AMA Steps Forward collection of practice improvement strategies. The STEPS modules help physicians determine how to report on quality metrics central to MACRA as well as the Physician Quality Reporting System. The STEPS modules each focus on a specific issue and offer solutions, steps for implementation, case studies, CME opportunities and downloadable additional tools.

In addition, the physician group has launched a podcast series, Inside Medicare’s New Payment System, featuring acting CMS administrator Andy Slavitt, AMA staff experts and other healthcare leaders. The series, which will include five episodes, should help get physicians up to speed on MACRA-related changes. I for one am eager to hear what Slavitt has to say about MACRA, as he is about the best source on the subject you could have.

At first glance, it doesn’t seem that the AMA plans to spend a lot of time on the Advancing Care Information subset of MIPS, better known as the replacement for the Meaningful Use program. I guess that’s not a huge surprise, given that physicians are still grappling with broad implications of MACRA which go well beyond HIT issues. However, given how important Meaningful Use has been to physicians over the past few years, one might expect it to get a little bit of special attention. Maybe they’re waiting for the MACRA final rule to come out.

With CMS casting a wider net and looking for more from medical practices than just adequate levels of EMR adoption, the AMA is probably following CMS’ path in talking about more than just the meaningful use (Advancing Care Information) portion of MACRA.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Providers Often Choose Low-Tech Collection Solutions

Posted on October 6, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As most providers know, it’s harder to collect money from the patient once they’ve walked out the door. This has always been an issue, but is particularly important today given that patients are being asked to bear an increasingly larger percentage of their healthcare bill.

In some cases, providers solve this problem by having their staff reach out directly via phone, rather than relying entirely on paper billing. Others address these issues with technology solutions such as offering payment options via a web portal. And of course, some providers do both.

But the question remains, which combination is most likely to boost collections efficiently without losing patients in the process? And it’s this question, which underlies all those other considerations, which a new study hopes to address. When reading the results, it’s good to bear in mind that the sponsor, BillingTree, is a payment technology firm and therefore has a bias, but the survey data was interesting nonetheless.

First, a look at providers’ collections challenges. Respondents told BillingTree that compliance and collecting payments once the patient has left the building were concerns, along with knowing the correct amount to bill after insurance and addressing the client’s ability to pay. Perhaps the biggest issues were a lack of payment channels – be they staffers, interactive voice response or website tech — and disputes over the amount billed.

According to BillingTree researchers, few respondents were using Web or automated phone payment collection technologies to bring in these missing dollars. While 93.9% accepted online and mail payments, and 86.7% said they accepted payments over the phone via a live agent, only 66.7% provided a web portal payment option, and just 6.7% offered the ability to pay via an interactive voice response system. Rather than add new technologies, respondents largely said that they intended to improve collections by adding staff members or outsourcing part of their collection operations.

On the other hand, technology plays a somewhat bigger part in providers’ future plans for collections. Over the next 12 months, 20% said they planned to begin accepting payments via a web portal, and 13.3% intend to add an IVR system to accept payments. Meanwhile, the 26.7% of providers who are planning to outsource some or all of their collections are likely to benefit indirectly from these technologies, which are common among payment outsourcers, BillingTree noted.

Among those providers that did offer phone or web-based payment options, one-fifth chose to add a convenience fee to the transaction. BillingTree researchers noted that given the low adoption of such technologies, and concerns about regulatory compliance, such fees might be unwise. Nonetheless, the data suggest that collection of such fees increase over time.

All this being said, the BillingTree study doesn’t look at perhaps the most critical technology issue providers are struggling to address. As a recent American Medical Association survey recently concluded, providers are quite interested in tools that link to their EMR and help them improve their billing and reimbursement processes.

Focusing on revenue cycle management issues at the front end of the process makes sense. After all, while patients are being forced to take on larger shares of their medical costs, insurers are still more reliable sources of income. So while it makes sense for providers to track down patients who leave without having paid their share of costs, focusing the bulk of their technology dollars on improving the claims process seems like a good idea.

Insightful Revenue Cycle Stats and Charts

Posted on March 2, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It never ceases to amaze me how many opportunities there are in medical practices to improve their revenue cycle management. You’d think we’d have solved this problem, but there is still so much opportunity to improve a practice’s revenue.

With this as the premise, I was interested in the revenue cycle management (RCM) survey report which offers up a number of stats and charts on such an important topic for practices.

Here’s one example chart from the report:
Percentage of Practices that Automate Revenue Cycle Management Chart

The thing about this chart that stands out for me is that almost all of them hover around 50% adoption. Some might say that this is pretty good adoption of these technologies. I see it as a huge opportunity for the other 50% of practices to adopt much of this technology.

The one that caught my eye the most is the “automated eligibility-inquiry checks.” Since reading Vishal Gandhi‘s posts on EMR and HIPAA, I’m a real convert to the importance of high quality, real time eligibility checking. Take for example his post on “The Eligibility Verification Time Suck” and “How Does a Practice Deal with All These High Deductible Plans?” This is a big deal for a practice’s revenue and is likely going to only get bigger as reimbursement continues to evolve.

There’s a lot more in the RCM survey report. Check it out and see how your practice can benefit from better revenue cycle management.

Healthcare Revenue Cycle Mastery

Posted on November 6, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the trends I see happening today is many organizations focusing too narrowly on things like meaningful use that they don’t take time to handle many of the important financial aspects of a practice. Many people call this revenue cycle management, but I loved how this whitepaper called it Revenue Cycle Mastery.

The reality is that there’s so much more to revenue cycle than most people realize. Most people think revenue cycle is just about focusing on collecting payments quicker and getting more patients to pay their bills. While those are both important aspects of your revenue cycle, there’s much more to revenue cycle mastery. The above whitepaper breaks up revenue cycle mastery into these areas:

Chapter 1 Financial Clearance
Chapter 2 Check-in and Check-out
Chapter 3 Charge Capture
Chapter 4 Coding
Chapter 5 Charge Entry
Chapter 6 Claims Management
Chapter 7 Patient Statements
Chapter 8 Payment and Denial Posting
Chapter 9 Insurance Follow-up
Chapter 10 Denial Management
Chapter 11 Patient Collections
Chapter 12 Payor Management

I’m sure that every healthcare organization can look through this list and see ways that they can improve their organizations approach to revenue. If you’re not sure what each section means, download the full whitepaper where they go into detail on each.

While I’m excited about the benefits of IT on improving healthcare, I also think there’s a tremendous opportunity to use IT to improve revenue. Every chapter listed above could benefit from a well implemented IT system. IT might not always be the right answer, but it can usually help you accomplish some part of the equation faster.

Which of the topics listed above do you think is most important for a healthcare organization to solve first?