fbpx

Top Takeaways from the Becker’s Healthcare IT & Revenue Cycle Conference

Part 2

For those of you who may have missed the Becker’s conference earlier this month, there were multiple educational opportunities. While there were 10 session tracks offered, I focused my attention on the revenue cycle track. This is partly because my company provides solutions in that area but also because there seems to be a lot of similar messages flying around across vendors, and I wanted to see for myself how relevant they are at addressing real revenue problems.
I had four key takeaways from the conference. Last week we talked about the importance of:

  1. Data in solving revenue cycle issues
  2. The critical role of people to the process (specifically patients and front-line staff members)

Today, we’ll focus on the third and fourth learnings – leveling the playing field with payers and the impact of surprise bills.

3. Leveling the Playing Field with Payers

One theme that kept coming up across multiple sessions was that many of the problems facing patients and hospitals can all be traced back to payers. “Payers keep changing the rules.” “They have more power than we do and they know it.” “We’re working through backlogs of denials just to find out they were incorrectly denied by payers who face no repercussions.”

One revenue cycle manager stated that he “used software to track the number of changes coming from payers’ rules – we got over one hundred thousand changes in 2018. We need all the help we can get because this is not sustainable.”

Using Data to Solve the Problem

Quarterly or annual negotiations are a provider’s chance to redefine contract terms, but payers have little to no incentive to change terms that usually benefit them.

Many of the providers who spoke on payer contracts stated that the biggest thing missing for them is data-backed reasoning for changes – “if we have detailed information and analyses on denial trends, payers will be more likely to make changes.”

Turning to Legislation

Healthcare organizations are starting to make bigger moves outside the walls of the negotiating room to try and level the playing field through legislation. Whether on a state-wide level or directly to federal budget committees, more and more providers are appealing to legislators for help.

Editorial Comment:

We discussed using data to pinpoint problem areas in last week’s post. It’s such a key component that it bears revisiting. As noted above, arming yourself with data intelligence will give you an edge when renegotiating your payer contracts. Another important use is for internal staff development, training, and incentive programs. If you know which departments or practices continue to make the same mistakes with coding or timeliness of claim submissions, you share the data with them so corrective measures can be engaged.

Secondly, with all due respect to our Legislative branch, those wheels often turn extremely slowly and do not immediately address revenue reimbursement problems that providers face today.

I agree with leveling the playing field. Here’s an approach that will make that happen sooner rather than late:

  1. Use the same data science payers use to delay reimbursement and use it to actually get claims paid faster rather than slower.
  2. Take advantage of machine learning to incorporate a perpetual learning loop into your process. That way smart claim edits will always be current regardless of whether a given payer’s rules have changed.
  3. Download this eBook: How to Win the Cat and Mouse Game with Payers. It’s a quick read, and I believe you’ll find the information helpful as you create strategies to improve reimbursement from payers.

4. Providers Bear the Blame for Surprise Bills

One of the most interesting conversations during a panel on “Surprise Billing” discussed the often-misplaced blame on providers when patients receive a surprise bill. “Providers frequently end up out of network because of contract stipulations directed by payers” – was a sentiment shared by all of the panelists.

A End Surprise Billing Act introduced in the House earlier this year is designed to eliminate surprise bills received by patients. However, this bill places the onus on the provider to alert the patient in advance of the out-of-network status, provide an estimate, and receive prior consent from the patient of these charges before any medical service is performed. All of which must be documented.

Editorial Comment:

The good news is that “surprise billing” has become prevalent enough for patients that lawmakers on both sides of the aisle are working together to try to find a solution for patients. The bad news is that the current proposals, while taking major strides in the right direction, seem to shift blame/burden for the surprise bill. Other legislative offerings, like New York’s Independent Dispute Resolution, seem to have a found a way to produce fair outcomes for both patient and provider.

The last interaction a patient has with a provider is the bill. Making that as benign an experience as possible starts way back before medical service was even provisioned. Alerting patients of the fees they will incur really shouldn’t even need legislation. Providing an estimate in advance along with payment options will not only create happier patients but deliver a huge boost to a provider’s ability to collect.

Consider the following patient payment stats:

  • 46% of patients claim they would pay a larger upfront sum if they received an estimate
  • 91% of patients say they can pay off their entire medical bill by following a payment schedule

These are pretty compelling stats that emphasize the importance of advance cost estimates and the availability of payment plans.

I’m interested in hearing your thoughts on the Becker’s conference. Any new concepts? Any new methods of addressing revenue collection issues?