Patient healthcare costs rise again lessen burdens increase revenue

Advertisements

“Patient Healthcare Costs Rise Again, Clinicspectrum’s Solutions Lessen the Burdens and Increase Revenue”

According to a recent article dated November 13th, 2014 on Forbes.com, “Worker Out-Of-Pocket Health Costs Have Doubled In Five Years”, the healthcare landscape is predicted to change even further in 2015.  “As the economy improves and employees spend more on health care, employer-paid premiums are rising again with an increase of 5.5 percent forecast for 2015 with worker premiums and out-of-pocket costs – which have doubled since 2009 – rising at an even faster clip.”  Additionally, the annual healthcare costs per employee have risen from $10,717 to $11,304 this year.  This means that more out of pocket expenses are outstanding and collecting that money can raise new challenges for medical groups.  Strategic solutions must be implemented in the areas of proper benefit verification, and automated patient collections to reduce revenue downfalls for practices.

 

In fact, practices are generating up to 30 to 40 percent of their revenue from patients who have high-deductible insurance coverage. Failing to check patient eligibility and deductibles can increase denials, negatively impact cash flow and profitability.

One solution is to improve eligibility checking using the following best practices:

-Check patient eligibility 48 to 72 hours in advance of scheduled visit using one of these three methods:

  1. Business-to-business (B2B) verification, which enables practices to electronically check patient eligibility using electronic data interchange (EDI) via their electronic health record (EHR) and practice management solutions.
  2. Look up patient eligibility on payer websites.
  3. Call payers to determine eligibility for more complex scenarios, such as coverage of particular procedures and services, determining calendar year maximum coverage, or if services are covered if they take place in an office or diagnostic center. Clearinghouses do not provide these details, so calling the payer is necessary for these scenarios.

-Determine patient financial responsibilities – high deductibles, out-of-pocket limits, then counsel patients about their financial responsibilities before service delivery, educating them on how much they’ll need to pay and when.

-Determine co-pays and collect before service delivery.

Another area of potential pitfall for revenue optimization comes from collecting patient balances after the services have been rendered.  It is imperative for medical groups to turn to automated solutions to help recover those balances seamlessly and effectively.

Automated collection software can be installed and managed by practices to relentlessly – within regulations – contact debtors to increase collection rates. Traditional collection methods of standard mail delivery and costly representative phone calls are replaced by a more elaborate, seamless, cost-effective auto collection process.  Automated collection methods using technology platforms, decisions rules and messaging such as text, email, push notifications on smart phones and automated calls to allow seamless, consistent results for balance collection.

For more information on ways we can help, visit our website, www.clinicspectrum.com.

 

Quit ‘Leaving Money on the Table’ with Automated Collection Software

At what point should practices “leave money on the table” and abandon their collection efforts on patient-owed balances? It’s a difficult decision that today’s practices are being forced to make more often than they’d like.

Automated Collection SoftwareCollecting past-due balances from patients is an important component of the revenue cycle that physician practices must actively manage, but it’s costly, time-consuming and labor-intensive. Only a relatively small percentage of efforts result in successful collection. For the remaining patients who fail to respond, practices are forced to report debts to credit bureaus or take legal action to collect past-due balances. In the end, every dollar invested in the collection process is one less dollar of profit for the practice.

But it gets worse. The cost of collecting on small-dollar accounts can easily exceed the past-due balance. The result is that many practices choose to “leave money on the table” rather than pursue advanced collection efforts. Over the course of year, these ignored accounts add up to a substantial sum of money.

Perhaps now, with the assistance of technology, practices will no longer have to make the decision to forego collecting past-due balances. A new breed of automated collection software eases the burden of patient collections. These solutions reduce the time and costs associated with standard mail delivery and costly representative phone calls.

Automated collection software can be installed and managed by practices to relentlessly – within regulations – contact debtors to increase collection rates. Practices that are considering the implementation of this software should look for the following capabilities:

  • Messaging Options – These allow practices to tailor how the patient will be contacted. Options include text, secure text, email, secure email, push notifications to smart phones, and automated calls. These options allow practice to contact debtors via multiple methods to increase collections.
  • Decision Rules – These allow practices to configure when and how often the debtor is contacted. Options include setting the date, time, hour and frequency of contact.

Practices employing automated collection software can reduce their collection costs and increase the chances of collecting balances by eliminating representative involvement and automating the process. Most importantly, practices can quit “leaving money on the table.”

How to create a delegated credentialing program?

Credentialing Services

This is part two of a two-part post that evaluates what is delegated credentialing and why healthcare provider organizations should consider it.

As explained in the first post of this two-part series, delegated credentialing is an opportunity for large provider organizations to take matters into their own hands, streamline processes and realize substantial benefits. These include getting providers credentialed quicker so they can generate revenue and expand clinical bandwidth.

So, how do organizations create a delegated credentialing services process? It entails establishing processes, as well as implementing tools to assist with workflow and manage the flow of data.

Key processes to implement include:

  • Adopting Credentialing Standards — The National Committee for Quality Assurance (NCQA) has already established standards for payers, as has the Joint Commission for providers. Standards from both organizations should be adopted, as well as any specific standards from regional payers.
  • Establish a Review Process — Create a committee to define processes and review provider credentialing.
  • Conduct Ongoing Monitor — Develop processes to continually monitor work quality.
  • Re-Credentialing — Create processes to easily re-credential providers on an ongoing basis.
  • Create Agreements with Payers — Delegated credentialing agreements need to be established, clearly stating structure and metrics, including:
    • Outlining the responsibilities of the payer and delegated entity.
    • Detailing metrics of how the payer can define and assess performance.
    • Developing ongoing oversight processes.

Accomplishing these processes requires sophisticated credentialing software that includes:

  • Analytics and reporting
  • Dashboard presentations and milestone tracking
  • Demographic import features
  • Document management
  • Reminders and notifications
  • Task management and assignment features

A key resource to assist with delegated credentialing programs is the Healthcare Billing and Management Association (HBMA). The organization has a number of useful resources that expound on the above in further detail.

Author Julia Solooki is a board member of the HBMA Education Committee.

Credentialing Dashboards Part 2 – Additional Capabilities to Evaluate  

Last week we wrote a brief overview of credentialing dashboards and several people contacted us with questions about additional dashboard capabilities. To address some of those questions, we’re highlighting some other important dashboard capabilities in this week’s post. Below are several key capabilities to look for when evaluating the dashboard components of credentialing solutions.

Milestones — Dashboards also need to display progress toward, or the completion of, key milestones so users can view specific activities within the credentialing process. This enables users to quickly know what’s completed, needs to be done, is past due, and what are the new tasks that are entering the process.

Drill-Down Capabilities — An overview status of processes is valuable, but users typically need more information. Drill-down capabilities allow users to click on elements of the dashboard to display specifics, whether it’s information about individual providers, payers, or other elements of the process. This enables users to efficiently get the information they need within one or two clicks.

The Ability to View Tasks and Processes from Different Perspectives — Not all users of the dashboard are looking for the same type of information. Some may be interested in looking payer-specific details, while others are more focused on working on tasks related to individual providers. The dashboard needs to accommodate these perspectives in its display to improve staff efficiency and improved workflow. For example:

  • Payer Information — Sections of the dashboard should display payer-related information, such as payer contact details, insurance PDF forms specific to the payer, web links, as well as counts of providers with insurance and their credentialing status.
  • Provider Information — Other sections of the dashboard need to display provider-specific information, such as the number of providers being credentialed and the status of specific tasks within the process. Drill-down capabilities within the section of the dashboard should enable the viewing of details, including in-depth provider profiles that include all credentialing-related information, as well as the wealth of information imported from the Council for Affordable Quality Healthcare (CAQH).

Specialized Capabilities — It’s important for dashboards to be user friendly and include features that make it easier for the staff to complete their jobs. Leading credentialing solutions include advanced features such as the ability to easily attach documents to records within screens, and capabilities to upload information from other data sources (e.g., CAQH and others). These capabilities reduce data entry, and make documents easier to find.

With dashboards, everyone remains on the same page and is up-to-date with the status of tasks, which increases the efficiency and effectiveness of the credentialing process.

Credentialing Dashboards Keep Staffs on Task, Better Communicate Status

Credentialing Services

Dashboards. To some, the concept is met with open minds and eagerness to view the data in a snapshot. To others, the term conjures up a notion of marketing spin. Can anything really be that great? The answer is yes. If done well, dashboards can not only brilliantly communicate key data to your staff, but keep everyone on task and efficient.

When looking at physician credentialing, communications are a vital part of the process, as everyone needs to know the status of tasks—what’s in progress and what remains to be completed. This information needs to be shared among various stakeholders, such as the credentialing staff, providers, practice administrators, and others. For credentialing, communicating this information is vital to practice operations, reducing risk, and ensuring that providers are eligible to receive reimbursement for their work.

Using a credentialing software solution with a dashboard display is an ideal way to share this information in a format that is easily digestible so information becomes actionable. Dashboards are a graphic representation displaying an up-to-date snapshot of tasks, whether they’re newly assigned, in progress, on hold, or past due. A credentialing system dashboard should be easily accessed, and provide an overview snapshot, milestones, drill-down capabilities, and the ability to view tasks and processes from different perspectives. Here’s a look at the first two of these.

Easily Accessed — When users open the credentialing system, the first thing they should see is the dashboard display. This quickly communicates the status of tasks, and alerts them to issues that need resolving. The easy accessibility of the dashboard eliminates the need for users to click through menus to view the information. It also decreases the chances that important information will get ignored, overlooked or simply not communicated.

Overview Snapshot — The dashboard should display a broad overview of the process that users can click on to get more detail, also known as “drill-down” capabilities, which are explained below. This overview enables the dashboard to display information of value to multiple user types, whether they are providers, practice administrators, or the credentialing staff. The dashboard should display:

  • Status of providers being credentialed (e.g., new, in process, on hold, completed, or custom credentialing)
  • Counts of providers with insurance
  • Status of the credentialing process by task
  • Credentialing task aging (e.g., 0-30 days, etc.)

Start by looking for these items in your dashboard, and watch your credentialing process go more smoothly.

 

*Photo is under Creative Commons License.

Show Me The Money

“Show me the money!” The famous phrase uttered by Tom Cruise in his role as Jerry Maguire, the fast talking sports agent in the 1996 hit film, has been echoed countless times. And when it comes to running your medical practice, seeing the money is an absolute necessity. You provide services to your patients, and you need to collect for them.

All too frequently practices pull their aging reports and 30,60,90—even 120 days out, there are unpaid claims. When added together, these claims are costing practices tens of thousands of dollars. On top of recouping these payments, then there is also the extra legwork that goes into denials management.

It’s inevitable that you don’t have a 100% clean claims ratio. It’s virtually impossible due to the fact that claims can be rejected for any number of reasons, ranging from lack of pre-certification or prior authorization, to diagnosis and procedure coding errors and omissions, to complicated workers’ compensation issues. In fact, according to the AARP, 200 million claims are rejected every year, and 60 percent are never resubmitted, resulting in a financial loss for the practice.

Imagine this:

– Shorter collection time

– Your staff freed for other office activities

– More money collected

It’s a reality. We can show you the money. Why continue to suffer with the burden of difficult-to-manage accounts receivable when you can rely on an outsourced staff that is tenacious and will relentlessly work to recoup your hard earned dollars. It costs $25 to $30 for you to manage the average denial, according to the Medical Group Management Association (MGMA). For a fraction of that cost, a devoted, experienced team can follow-up on your report. And in the event of the claims denials, our experts won’t stop till they have identified the reason for the denial, helped correct the issue, and gotten you your money—faster.

Clinicspectrum is a healthcare services company providing outsourcing/back office and technology solutions for 17+ medical billing companies, 600+ medical groups/healthcare facilities including hospitals, and hospital medical records departments.