Today in healthcare, with seemingly ever-changing reimbursement rates, ICD-10 complexities, the increasing prevalence of high-deductible health plans and more, it’s imperative that provider organizations do everything they can to capture all of the revenue that’s owed to them by insurance payers.
Insurance reimbursement is still the largest and most predictable portion of revenue received by a provider. Whether a large hospital, a smaller physician specialty practice or something in between, ensuring collection of 100% of that revenue has never been more important.
That excerpt from our recent RCxRules eBook, Lean Principles, Clean Data and Your Business Office: A Focus on Quality is Now a Requirement in Healthcare, concisely sets the stage for a significant challenge facing healthcare providers—collecting from payers in today’s complex reimbursement environment.
As progress continues to be made rolling out the multitude of provisions within the Affordable Care Act (ACA), provider groups should be seeing more patients with insurance coverage than in previous years. In fact, the CDC estimates the percentage of uninsured Americans has fallen from 15.7% to 9.2% under the Affordable Care Act. This would be the lowest rate of uninsured Americans in 50 years.
On the face of it, this should be good news for providers, right? More people have insurance and that should improve revenues for hospitals and physician practices, correct? Well, the numbers are largely bearing that out to be true. After several years of slower growth, healthcare spending in the US increased by 5.4% in 2014 over the previous year.
However, the structure of the insurance plans of today are different than the plans of yesteryear. Many Americans are moving, or being told to move by their employer, to high-deductible plans. While this helps keep the monthly premiums lower than they otherwise would be, the patients’ end up responsible for a high percentage of the total bill.
Overall, provider groups should benefit from the additional insured Americans covered under the Affordable Care Act. However, medical groups must continue to be extremely focused on “operational excellence” within their revenue cycle operations. With reimbursement rates continuing to be under pressure and with patient payment ratios continuing to climb, providers must do everything they can to ensure they are collecting every dollar due to them. Here’s another excerpt from our Lean Principles, Clean Data and Your Business Office: A Focus on Quality is Now a Requirement in Healthcare eBook:
For providers large and small, collecting payment from an insurer can be difficult to say the least. No one has to tell you that denials are now an all-too-common reality…Staying on top of these challenges and others requires a lot of attention and expertise, and many providers are struggling.
The ramifications of subpar performance when it comes to denials and insurance collections could severely hinder any provider organization, and we’ll be talking about this subject a lot over the coming months. In the meantime, we’d like to offer you a free copy of the eBook we’ve been referencing, which goes into much greater detail on this all-important subject.
Access your free copy of Lean Principles, Clean Data and Your Business Office: A Focus on Quality is Now a Requirement in Healthcare now.
