Healthcare practices must contend with many challenges throughout the year, from adopting new technologies to managing health outcomes for any number of patients. Numerous factors can add up to have a dramatic effect on revenue cycle management, creating positive - and negative - changes in providers' bottom lines.
Medical practices are businesses, and funds must be controlled to maintain profitability. According to a survey from TransUnion Healthcare, three-quarters of patients believe that knowing their out-of-pocket costs for treatments would improve their ability to pay for health services.
The poll included more than 700 respondents who were insured healthcare patients. In contrast to the initial 75 percent, the results also showed that 56 percent either rarely or never received a cost estimate before treatment, and 59 percent said they were surprised by the costs they were responsible for.
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Now, more than ever, it is critical that providers capture all reimbursements owed to them, given the impending changes to reimbursement structures under the Affordable Care Act and the introduction of healthcare exchanges," said John Woody, VP of Product Development for TransUnion, according to a press release.
Following the rollout of the Obamacare website, many states offered exchanges for insurance to facilitate the adoption of new health coverage. However, EHRIntelligence reported that there's still some confusion about what's covered under the Patient Protection and Affordable Care Act. Having a thorough understanding of coverage can have a significant benefit to providers, as accurately verifying patients' benefits and eligibility can help them avoid billing errors and claim denials.
Run review programs
Practices can implement medical necessity review programs to ensure that certain procedures are being covered by payers. According to EHRIntelligence, experts in Medicare estimated that providers who don't practice necessity reviews could lose an average of $960,000 per year in denials. The time and resources it takes to gather additional information and resubmit the documentation could wind up costing roughly $117 per denied claim.
As part of the program, physicians could also include a checklist to ensure the proper registration guidelines are followed by staff. Becker Hospital Review explained that the beginning of the revenue cycle can offer providers many chances to experience financial growth. The initial interaction can include administrative tasks such as photocopying insurance cards and reviewing and verifying patient insurance information. The latter can ensure a fluid claims process, effectively reducing the instances of denied claims by payers.
Finally, providers could also begin contacting patients pre-admission in order to update any old information and develop a payment plan, if necessary. From there, credit card information could be used to pay for the appointment or service before the patient comes into the facility.