Providers eager to embrace technology, freeing them from billing and payment burdens
Hospital margins and revenues continued to fall in November, while expenses remained above 2019 levels, according to Kaufman Hall's December Flash report, which examines metrics from the previous month.
The median hospital operating margin in November was 2.5% year-to-date with funding from the Coronavirus Aid, Relief and Economic Security Act. Without the funds, the median hospital operating margin narrowed to -1.1%.
Skyrocketing COVID-19 cases are already stretching hospitals' capacity, and Kaufman Hall expects the situation to worsen in coming months as holiday gatherings and colder weather push case counts up even further.
Going into 2021, uncertainty still looms but one thing is for certain: technology will continue to transform the healthcare landscape. Looking specifically at the financial aspects of care, we’ll see more providers embrace technology that frees them from the administrative burden associated with billing and payments.
Below, we highlight five challenges facing revenue cycle professionals and how we can help tackle them.
1) Growing and aging accounts receivable (AR)
Challenge: Now, more than ever, it will be essential for healthcare providers to maintain a streamlined revenue cycle that focuses on efficient patient and insurance collections, denial management and claim follow-up. Many providers’ backlogs of patient balances often fall to the wayside, exacerbated by payer denials and general issues like insufficient documentation, coding omissions, and timely follow-up. Providers which have implemented targeted A/R reduction strategies including past due accounts focus, denial prioritization and root cause remediation typically experience lower AR days. Furthermore, practices should consider improving access to financial insights either by adding new technology or maximizing their current technology. Practices should strive to identify financial trends, threshold events and other AR vital signs.
Unified RCM: Our revenue cycle management solution helps providers simplify medical billing, increase revenue and decrease bad debt. Our solutions manage the entire revenue cycle by conducting a thorough and continuous analysis of front-end to back-end revenue processes to help deliver the best possible patient care without compromising reimbursement goals.
Patient Access by Quadax: Our configurable software and streamlined workflow ensure successful outcomes at each patient touch point: insurance verification, patient pay estimates, medical necessity and propensity to pay, while merging front and back end functions, leveraging data and collecting payments upfront. Rest assured, every procedure rendered can be billed with near certainty to its accuracy and probability to collect.
Denial Management: Quadax provides easy-to-use tools for the automatic creation of custom worklists and intelligent routing of denials to the appropriate staff in your organization for rapid follow-up. Expect to reduce future denials and rejections by improving claim accuracy, and increasing efficiency and staff performance with automation.
Advanced Claim Status: Easily create rules to query a claim’s status. Our advanced screen-scraping technology will secure the most up-to-date and actionable responses from the payer’s site and workflow claims by exception so you only focus on manual work where it’s required.
Data Analytics: Intelligence by Quadax is a critical reporting and analysis solution that delivers easy access to key performance indicators (KPIs) and other measurements of financial and operational health. Components of Intelligence by Quadax include Decision Intelligence, Predictive Intelligence and Data Intelligence.
2) Increased patient financial responsibility
Challenge: Market trends over the past several years have increased the patient responsibility ratios through higher copay and deductible plans. Given this shift in financial responsibly, providers must consider implementing policies and processes, as well as automation to help drive more consistent patient behavior. Enablement of convenient and efficient options for patients to understand balances, submit payments and communicate with the practice, are a few methods practices have adapted to increased consumerism demand within the healthcare industry. Technology that enables patient consumerism and results in more pleasant and streamlined patient experience will continue to be a major competitive advantage for healthcare providers.
Patient Engagement by Quadax: Provides a secure gateway where customers—patients and Quadax clients—can engage and exchange information, while determining patient financial responsibility before a test is ordered and after insurance has processed the claim for improved patient satisfaction and reimbursement.
3) Changing government requirements and regulations
Challenge: In these uncertain and ever-changing times, payers are changing the rules and payment standards. As government and private payers continue to develop and change quality improvement (QI) programs, practices will continue to experience increased pressure, having to balance high quality patient care while ensuring QI regulations are adhered to. Maximizing reimbursement and minimizing penalties is the new normal. Healthcare providers have found relief from this increased pressure by partnering with an expert. As an example, as the current pandemic unfolded, telehealth adoption continued to increase, and reimbursement rules continued to change. While telehealth has both helped minimized COVID-19 exposure to patients and provided a new source of revenue for physicians, many providers were challenged with maximizing reimbursement. Providers aligned with an expert revenue cycle partner were able to remain current and educated on these ever-changing initiatives.
Rely on the experts. Our comprehensive, up-to-date library of claim processing rules and edits are updated bi-weekly by our Edits & Documentation Group (EDG). The Quadax EDG team of experts, who are knowledgeable in both billing and ANSI claim requirements, reference nationally recognized sources, including AMA, CPT guidelines, Medicare Physician Fee and more.
4) Pressure for cost reductions
Challenge: The pressure to reduce costs and increase margins seems to get higher and higher for healthcare providers as the global pandemic continues. This puts additional pressure on healthcare executives to make sure their organizations are getting completely reimbursed for all services they provide to their patients. Focus on charge capture enablement, denial management efficiency and payer contract compliance, must be at the forefront of their revenue cycle procedures to facilitate compliance and revenue capture.
Contract Management by Quadax: Identify expected reimbursement and workflow underpayments, and pursue revenue recovery with Contract Management by Quadax. Our contract modeling feature accommodates all net patient service revenue contracts and all payment terms and conditions for multiple years—including Medicare/Medicaid schedules, professional and institutional claims, fee schedule, percent of charges, percent of Medicare/Medicaid, carve-outs, outliers and more. Actionable workflow enables staff to pursue priority claims during pre-billing based on expected revenue versus total charge. With Contract Management by Quadax, you can calculate cash flow with confidence and decrease days in A/R while adding to your bottom line.
Predictive Intelligence by Quadax: Prediction of denials, time-to-payment, and many more insights allow for adjustments to billing and workflows and to project cash flow at any given time–all of which helps to further optimize the organization’s revenue cycle strategy to support growth and operational goals.
5) Lack of access and visibility into data
Challenge: Many providers suffer from a lack of revenue cycle information and insights, while other hospitals spend many hours each month scrubbing, importing and exporting data into the formats and context they require. The proper technology enables transparency into areas such as physician productivity, staff productivity, denial trends and other revenue cycle metrics which assist in data-driven decision making for improved financial outcomes. Providers who maximize their current technology’s reporting capabilities or layer on an additional analytics technology have generally solved their data gaps and improved in areas such as accurate and complete reporting, denial management and maximized net-collection rates.
Intelligence by Quadax: Stop the guesswork—know what payers require by examining payer data trends, account for revenue losses and time, and investigate areas where efficiencies can be realized. Intelligence by Quadax uses the most advanced, innovative tools and cloud services to continually collect and analyze your complex revenue cycle data from disparate systems into a single source of truth. You can identify contributing factors, investigate cause-effect relationships, reveal opportunities, and measure results against internal goals and industry benchmarks. Export reports or display visual representation of real-time data and analytics you can use during executive reviews or in summarization reports.
As the COVID-19 pandemic continues to unfold, we are optimistic about our future, especially as our healthcare system becomes increasingly tech-driven and consumer-centered. We expect to see organizations that embrace modern technology adapt more easily to shifting environments, succeed financially and remain focused on improving patient care.
Let’s take on the revenue cycle together—rely on our experts while you focus on what really matters—providing unrivaled patient care!