With patients seeing higher medical bills than ever and healthcare costs continuing to rise, healthcare organizations need to stay on top of the revenue cycle to ensure they can capture payments and be prepared for changes in 2020.
Speaking at the annual meeting of the American Health Information Management Association (AHIMA) in Chicago, Cassi Birnbaum, MS, RHIA, CPHQ, FAHIMA, enterprise director of HIM and revenue integrity at UC San Diego Health, outlined how her organization is staying up to date on revenue cycle management and leveraging new innovations for 2020.
UC San Diego is an academic hospital system with three hospitals and more than 9,000 employees.
The organization is focusing on its revenue cycle management at a time when fewer U.S. patients can afford to pay their medical bills as a result of rising healthcare costs. In fact, 1 in 4 people have an unpaid medical bill, while 10% have a bill they cannot pay at all and 20% are paying a medical bill over time, according to the National Center for Health Statistics.
However, to ensure patients pay their bills and organizations can depend on this revenue, revenue cycle management and optimization is critical.
There are also other factors at play that healthcare organizations should keep in mind. M&A activity in the healthcare marketplace is also rapidly upsetting the normalcy of the space.
From blockbuster deals such as CVS Health’s $69 billion takeover of health insurer Aetna to new entrants like Uber and Lyft partnering with healthcare organizations for transportation and Amazon joining forces with Berkshire Hathaway and JPMorgan Chase & Co. for a venture to solve internal health insurance costs, the healthcare space is seeing rapid changes, Birnbaum said.
“Our marketplace is being turned upside down, and with an election year, who knows?” Birnbaum said of what is to come.
At the same time, hospitals are seeing more regulations when it comes to price transparency, with HHS proposing for negotiated rates for services between healthcare providers and insurers to be posted publicly online.
The proposal could affect “whatever competitive arrangements you have with your payers,” Birnbaum warned, noting the change is “very, very frightening.”
With these issues in mind, US San Diego says it wants to “eliminate the element of surprise” when it comes to billing and improve revenue cycle management.
Some of the best ways to do so include having patient estimations that let the patient know what they are responsible for at the end of the visit. From there, healthcare organizations also need to be sure to have new approaches to validate the estimates from the patient estimation tool and ensure there is an acceptable threshold for error.
Massachusetts is one state that has taken the lead on this, requiring patient estimates that provide prices and online tools, with estimates delivered to patients within two business days.
Another good example is Ochsner Health System, based in Louisiana. The healthcare organization started calculating patients’ out-of-pocket amounts based on payer contract terms and made that information part of a patient portal estimation process that also includes an alert system to let patients know of upcoming deposit responsibility and calls for patients who are not financially cleared five days prior to their service. Patient estimates are also audited manually, but the audits will be automated in the future, Birnbaum noted.
These elements incorporate best practices when it comes to revenue cycle optimization and leave a better experience for the patient. Healthcare organizations should also create surveys to gain feedback on the patient prospective to pay.
For UC San Diego, leveraging technology for eligibility and authorization has also been key, and Birnbaum urges other providers to not be afraid of “dipping your toe into some of the new and emerging technology,” particularly if can bring about ROI. These include AI, blockchain, charge capture integration, underpayment automation, predictive modeling, advanced portal solutions, cloud-based solutions and more.