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Problematic Medical Bills Drive Consumers To Cut Back On Care

Posted on November 7, 2018 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 we all know, patients and families are taking over responsibility for a steadily greater percentage of their healthcare costs over time. Not surprisingly, this can affect their medical decisions in negative ways. In fact, a new study has documented that their medical bills are confusing or unexpected, a patient may get overwhelmed and simply skip some forms of care entirely.

The study, which was conducted by Hanover Research and sponsored by HealthSparq, surveyed more than 1,000 Americans on their experiences with unexpected medical bills. The results should be unsettling to anyone in outpatient services, especially those in primary care.

Researchers found that more than half (53%) of respondents had received a surprise medical bill over the past 12 months. This included bills that were higher than expected (60%), for services they thought were covered by insurance but weren’t (62%) and from multiple providers when they expected to get just one (42%).

When faced with these frustrating billing situations, patients may drop out of their care routine to some extent. Many skip routine checkups (40%), routine health screenings (39%) or care for injuries (39%).

A substantial number of respondents (40%) conceded that they could’ve avoided such shocks by doing more to better understand their benefits and healthcare processes, in addition to blaming their insurers (45%) or their health providers (42%). Regardless, it appears that a large number didn’t know who was responsible for the problem, which doesn’t bode well for their future health behavior.

Look, everyone knows that offering an accurate estimate of patient financial liabilities could be a nightmare in some situations, particularly if insurance companies don’t play nicely with the billing department. It’s also true that in some cases, patients simply won’t be able to pay the bill regardless of how you present it, a problem you certainly can’t surmise on your own as a medical practice.

That being said, you can take a look at the bills your practice management system produces and get a sense whether they’re decipherable to those who don’t work within the organization. Even if the PM system does a good job of supporting your end of the process, that doesn’t mean it’s turning out bills that patients can use and understand.

Yes, arguably the most important thing a practice management system does is to support your claims process effectively, but seeing to it that patients aren’t overwhelmed by their bills is clearly a big deal too. Particularly under value-based care, you can’t afford to have them holding off on the services that will keep them well.

Revenue Cycle and Patient Communication Dominates MGMA18 Exhibit Hall

Posted on October 3, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Two themes emerged from the exhibit floor of this year’s MGMA annual conference (1) Practices are spending money on improving Revenue Cycle Management – RCM and (2) Practice managers are looking for more comprehensive ways to communicate with patients.

The exhibit hall of the 2018 MGMA Annual Conference (#MGMA18Annual) came to a close today and as the booths were quickly deconstructed, I took time to reflect on 25 pages of notes that I took from the various conversations I had. As I flipped through my blue-ink chicken scratches, I kept seeing two words in the margins: “PtComm” (my short hand for Patient Communication) and “RCM” (Revenue Cycle Management). On page after page, I scrawled these words to summarize the conversations.

In the Health iPASS booth, I had the chance to speak with one of their customers – Judith Basile, MSM, FACMPE, Practice Administrator at Associates in Orthopedics. Basile told me that implementing Health iPass’s RCM platform made “a huge impact on the financial health” of their practice and that it allowed them to “catch up to the consumer experience patients have outside of healthcare, where they can make payments quickly and easily”. With Health iPASS, Associates in Orthopedics experienced a 35% improvement in patient payments. They had only been on the platform for 18 months.

Over in the Pulse Systems booth, I spoke with Dar Griffeth, the company’s new SVP of RCM Services. Griffeth’s role was created because the company recognized the need their customer had for expert RCM advice. His job is to work with customers to identify how components of the Pulse solution can be adapted to improve the RCM process. This is in contrast to the common approach of deploying technology and then redesigning the workflow to fit – an approach that often results in slow adoption or outright failure. Griffeth’s role would not exist if RCM was a low priority for physician practices.

Matthew Hawkins, CEO of Waystar, the company that resulted from the combination of ZirMed and Navicure, shared where they had been focusing some of their development efforts. “Lately we have been focused on helping reduce or eliminate claim denials,” said Hawkins. “Having a claim denied is terribly inefficient. Practices have to spend precious time and effort investigating and correcting the claim. We thought – why does it have to be this way? What if we could eliminate denials altogether? That’s what we’ve been working on and our customers are happy we have made significant strides in this area.”

The exclamation point was Waystar’s announcement that it was acquiring Ovation – a claims monitoring technology from UPMC to further enhance Waystar’s claims processing platform.

The conversation turned to patient communications when I stopped to speak with Rick Halton, VP of Product and Marketing at Lumeon. I was unfamiliar with Lumeon and was curious to find out more. Halton argued convincingly that the current paradigm of care coordination was flawed – that the top-down approach where a central care coordinator is expected to shoulder the work to gather data from patients and keep patients adherent to their care programs. was doomed to fail. Instead, an approach where patients are full partners in their care was needed. In Halton’s opinion, the key was two-way communication between patients and their care teams.

Lumeon’s Care Pathways Management platform allows for a more automated and orchestrated approach to care delivery. One that is centered on the ability for patients and care teams to communicate in a seamless manner via text and in-app messages. “Everything from discharge to pre-operative readiness to lifestyle coaching is possible through the platform,” said Halton.

In prior years at MGMA, whenever I talked to people about patient communications my conversations were only about sending out appointment reminders and links to patient educational materials. What Lumeon was showing me was true 2-way communication with patients across many care scenarios.

Further evidence of this shift in patient communications came from my conversations with Well Health, Rhinogram and CareCloud.

Well Health makes a platform that consolidates all patient communications in one place – and allows for seamless transition from broadcast message delivery to real-time two-way communication with patients. Their interface looked intuitive and because they system stored all prior communications, it allows practices to quickly reference prior conversations, helping staff get to the heart of the issue more quickly than having to search through the EHR.

“It’s all about making it easy for both the patient AND the staff in the healthcare organization,” said Bill Kinner, President of Well Health. “We have to realize that in the world of value based care, effective 2-way communication with patients is the cornerstone to keeping people healthy. It’s the last mile of any population health, medication adherence or mental health program.”

Rhinogram had a similar philosophy. A relative newcomer to the ambulatory space, the company has enjoyed years of success with dental practices. I asked Dr Keith Dressler, Chairman & CEO of Rhinogram what set their system apart from all the others on display at MGMA: “Quite simply we see ourselves not as a communication platform, but as an asynchronous telehealth platform that uses text, Facebook Messages and other channels rather than real-time video to connect with patients”

Dressler’s response was a great way to reframe the entire patient communication space and showed me that vendors were moving away from their provider-initiated communication roots to include patient-initiated communication as well.

Nowhere was this shift more apparent than in the CareCloud booth. A year ago I wrote a post about the launch of the company’s then-new Breeze platform – a patient experience platform built in partnership with First Data. Breeze was designed to be the backbone for all sorts of new patient engagement applications. At MGMA18, CareCloud announced the launch of a customizable survey tool for capturing patient satisfaction information on Breeze.

“Our new survey capability is very exciting,” said Juan Molina, Vice President of Strategy and Business Development at CareCloud. “The surveys are customizable by the practice without the need for development resources. This allows our customers to quickly construct surveys that can gather patient feedback on anything – new programs they want to offer or changes they want to make to the practice itself. The sky is the limit. But at the core, this survey capability means our customers have another way to engage patients in a 2-way conversation about their experience.”

I must admit, prior to MGMA18 I had thought the patient communication space was played out. But having spoken with every patient communication vendor on the exhibit floor, I have a new appreciation about where the technology is headed. I’m actually excited to see what advancements will be made in the next 12 months.

PS: I also had great conversations with Kevin Pho MD – founder of KevinMD.com, Todd Evenson – COO at MGMA, Corinne Proctor Boudreau – Senior Manager at MEDITECH and Niko Skievaski – cofounder & President at Redox. Those conversations will be the subject of upcoming articles.

Medical Practice Use Of Automated Claims Options Growing Slowly

Posted on June 25, 2018 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 study by a healthcare industry group has concluded that medical and dental practices are processing claims manually rather than going for full automation, a trend which is robbing the industry of very high levels of potential savings. While many physicians and dentists are using web portals to process claims, in most cases they haven’t reached the ”set it and forget it” level, a trend which could undercut possible savings.

The group, CAQH, tracks health plan and healthcare provider adoption of electronically-based administrative transactions for medical and dental practices. CAQH’s research estimates the time required for providers administrative transactions, including verifying a patient’s insurance coverage, sending and receiving payments, checking on the status of claims and handling prior authorization processes.

Its research concluded that despite the potential rewards, the medical and dental practices made only a modest level of progress in automating claims and related business processes over the past year. According to CAQH calculations, practices are still leaving roughly $11.1 billion in savings on the table, an estimate which has climbed by $1.8 billion over the prior year.

If these savings are realized, the majority ($9.5 billion) would end up in providers’ hands. However, many practices just haven’t gotten there yet.

A rise in portal use is certainly an improvement over paper-based claims processes. In fact, some of the increase in potential savings noted by the study is being created by a rise in online portal use.

However, providers’ adoption of fully-electronic claims is basically growing only a small amount or even declining for most transactions that can be done via a portal. For example, for prior authorizations, a big increase in portal use correlated with the decline in the adoption of fully-electronic transactions.

For CAQH, the endgame is getting all providers to automate claims processes complete, so the modest to flat growth in automated claims transactions is not exactly good news. In fact, it’s not a winning situation for medical practices either. According to the group’s estimates, each manual transaction costs practices $4.40 more than each electronic transaction and eats up five more minutes of provider time, which can create a real drag on profits.

Meanwhile, processing a single claim electronically through its lifecycle would save medical practices almost 40 minutes on average, and more than $15 in direct cost savings. Meanwhile, processing a single dental claim from start to finish could save dental practices almost 30 minutes on average and almost $11.75.

The CAQH press release doesn’t spell out what’s holding dentists and doctors back from automating the claims process completely, but it’s not hard to guess was going on. Unlike some providers, medical and dental practices typically don’t have deep pockets or large staff they can make this transition. If health plans want these providers to get on board, they’ll probably have to help them make the transition. However, even health plans haven’t invested in automated claims processing enough either.

Cloud-Based EHRs With Analytics Options Popular With Larger Physician Groups

Posted on April 20, 2018 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.

Ever wonder what large medical practices want from the EHRs these days? According to one study, the answer is “cloud-based systems with all the bells and whistles.”

Black Book Research just completed a six-month client satisfaction poll questioning members of large practices about their EHR preferences. The survey collected data from roughly 19,000 EHR users.

According to the survey, 30% of practices with more than 11 clinicians expect to replace their current EHR by 2021, primarily because they want a more customizable system. It’s not clear whether they are sure yet which vendors offer the best customization options, though it’s likely we’ll hear more about this soon enough.

Among groups planning an EHR replacement, what appealed to them most (with 93% ranking it as their preferred option) was cloud-based mobile solutions offering an array of analytical options. They’re looking for on-demand data and actionable insights into financial performance, compliance tracking and tools to manage contractual quality goals. Other popular features included telehealth/virtual support (87%) and speech recognition solutions for hands-free data entry (82%).

Among those practices that weren’t prepared for an EHR replacement, it seems that some are waiting to see how internal changes within Practice Fusion and eClinicalWorks play out. That’s not surprising given that both vendors boasted an over 93% customer loyalty level for Q1 2018.

The picture for practices with less than six or fewer physicians is considerably different, which shouldn’t surprise anybody given their lack of capital and staff time.  In many cases, these smaller practices haven’t optimized the EHRs they have in place, with many failing to use secure messaging, decision support and electronic data sharing or leverage tools that increase patient engagement.

Large practices and smaller ones do have a few things in common. Ninety-three percent of all sized medical and surgical practices using an installed, functional EHR system are using three basic EHR tools either frequently or always, specifically data repositories, order entry and results review.

On the other hand, few small to midsize groups use advanced features such as electronic messaging, clinical decision support, data sharing, patient engagement tools or interoperability support. Again, this is a world apart from the higher-end IT options the larger practices crave.

For the time being, the smaller practices may be able to hold their own. That being said, other surveys by Black Book suggest that the less-digitalized practices won’t be able to stay that way for long, at least if they want to keep the practice thriving.

A related 2018 Black Book survey of healthcare consumers concluded that 91% of patients under 50 prefer to work with digitally-based practices, especially practices that offer conductivity with other providers and modern portals giving them easy access to the health data via both phones and other devices.

#HIMSS18 First Day:  A Haze Of Uncertainty

Posted on March 7, 2018 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.

Entering the HIMSS exhibit area always feels like walking straight into a hurricane. But if you know how to navigate the show, things usually start to come into focus.

There’s a bunch of young, scrappy and hungry startups clustered in a hive, a second tier of more-established but still emerging ventures and a scattering of non-healthcare contenders hoping to crack the market. And of course, there are the dream places put in place by usual suspects like Accenture, SAP and Citrix. (I also stumbled across a large data analytics company, the curiously-named splunk> — I kid you not – whose pillars of data-like moving color squares might have been the most spectacular display on the floor.)

The point I’m trying to make here is that as immense and overwhelming as a show like HIMSS can be, there’s a certain order amongst the chaos. And I usually leave with an idea of which technologies are on the ascendance, and which seem the closest to practical deployment. This time, not so much.

I may have missed something, but my sense on first glance that I was surrounded by solutions that were immature, off-target or backed by companies trying to be all things to all people. Also, surprisingly few even spoke the word “doctor” when describing their product.

For example, a smallish HIT company probably can’t address IoT, population health, social determinants data and care coordination in one swell foop, but I ran into more than one that was trying to do something like this.

All told, I came away with a feeling that many vendors are trapped in a haze of uncertainty right now. To be fair, I understand why. Most are trying to build solutions without knowing the answers to some important questions.

What are the best uses of blockchain, if any? What role should AI play in data analytics, care management and patient interaction? How do we best define population health management? How should much-needed care coordination technologies be architected, and how will they fit into physician workflow?

Yes, I know that vendors’ job is to sort these things like these out and solve the problems effectively. But this year, many seem to be struggling far more than usual.

Meanwhile, I should note that there seems to be a mismatch between what vendors showed up and what providers say that they want. Why so few vendors focused on RCM or cybersecurity, for example? I know that to some extent, HIMSS is about emerging tech rather than existing solutions, but the gap between practical and emerging solutions seemed larger than usual.

Don’t get me wrong – I’m learning a lot here. The wonderful buzz of excited conversations in the hall is as intense as always. And the show is epic and entertaining as always. Let’s hope that next year, the fog has cleared.

RCM Tips & Tricks: Shortening Length of Claims In Accounts Receivable

Posted on December 21, 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.

There’s little question that health insurers do little to help your medical practice collect the reimbursement you’re due.  Not only that, ongoing changes in federal laws make improving your collections levels even more difficult.

As a result, physician practices need all the help they can get in shortening the days claims spend in Accounts Receivable, including the seemingly obvious challenge of collecting payment in full from payers, which don’t even honor rates set forth in reimbursement contracts in some cases.

Given these challenges, medical groups need all the help they can get in improving A/R. Here are some tips from medicalbillersandcoders.com:

  • Find claims which might be rejected ahead of time before submitting them to payers. Claims not paid when first submitted are far less likely to ever get paid.
  • Identify such claims using software that can track and respond to rules and regulation changes by payers. This software should also take into account the rate of denials by a given payer for all doctors.
  • Use software (such as practice management tools) to track all payments, and make sure that your practice is paid based on the terms the payer has agreed upon. Insurers pay less than promised for roughly 10% of claims.
  • Create a detailed system to address the aging of receivables, then track those claims by payer, as various payers might have different payment schedules and different procedures for addressing late reimbursement.
  • Make sure you follow up on unpaid claims as quickly as possible, as the sooner your practice follows up with health insurers the more likely you’ll get paid, and the less likely the claim will end up lost or ignored.
  • Using electronic tools, see to it that your A/R workflow is efficient, or your group may endure errors in documentation which slow down reimbursement. Practice management software can be helpful in addressing this problem.

Practices with a large budget may be able to invest in sophisticated, expensive tools which can perform in-depth claims analysis. This can help such practices improve time in A/R for claims.

However, if your practice is smaller and its budget can’t absorb high-end analytical tools, you can still improve your collections by being thorough and having a good workflow in place.

Also, it’s smart to make sure everyone on your staff is aware of your A/R goals. Even if they don’t have direct contact with collections or A/R, they can be the eyes and ears which help the process along.

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.