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How the Affordable Care Act Refines Revenue Cycle Management

The Affordable Care Act has contributed toward greater revenue cycle management complexities. But it also allows healthcare providers to improve, excel, and differentiate.

By Jacqueline DiChiara

- The Affordable Care Act (ACA) provides many greater opportunity for healthcare providers to strengthen their revenue cycle operations. As a consumer-driven revenue cycle management is becoming the new norm, the ACA plays an active role in healthcare’s evolution.

affordable care act revenue cycle management

Here are 4 ways the healthcare revenue cycle has shifted since implementation of the ACA.  

The ACA is perhaps working as intended to improve outcomes

“More and more families are choosing high deductible health insurance plans. The ACA really hasn't changed the trend towards patients paying a greater share of the total share of care out of their pockets,” said Josh Gray, Vice President of Research at athenahealth, to RevCycleIntelligence.com.

“The ACA was really supposed to improve outcomes by dramatically improving access to healthcare. There's no question that the uninsurance rate has gone down and that previously uninsured people are getting care. It's a more dignified process than it has been in the past. So in that sense the ACA is working as intended.”

“The ACA has some unfinished work to do in terms of more carefully designing benefits structures so patients will not face financial pressures to skip beneficial care.”

The ACA helps maintain affordable premiums

“The Affordable Care Act brings an unprecedented level of scrutiny and transparency to health insurance rate increases,” explained the Centers for Medicare & Medicaid Services (CMS).

“The Act ensures that in any State large proposed increases will be evaluated by experts to make sure they are based on reasonable cost assumptions and solid evidence.”

“This analysis is expected to help moderate premium hikes and provide those who buy insurance with greater value for their premium dollar.”

”Additionally, insurance companies must provide easy to understand information to their customers about their reasons for significant rate increases, as well as publicly justify and post on their website any unreasonable rate increases.”

The ACA supports the shift from volume to value

Revenue cycle management investment efforts have been tied to data analysis, actionable insight, benchmarking, and performance assessment. Essentially, the ACA allows for greater revenue cycle management flexibility.

“Some physicians have been less aggressive in investing in technology or adopting new technology. If your system can’t pull that information out and you can’t report on it, your practice will be subject to future CMS payment penalties,” stated Dan Clark, McGladrey’s Director of Revenue Cycle.

The ACA has contributed complexities to revenue cycle operations, but it also presents an opportunity for providers to improve, excel, and differentiate.”

 “Providers who can adapt their revenue cycle management processes to take advantage of the current post-reform, consumer-driven environment will be in a position to benefit.”

The ACA may be favorable to females’ wallets

The ACA allegedly attempts to provide more coverage to women compared with previous healthcare provisions.

Nearly 19 million women who were formerly without health insurance became eligible for coverage last year.

Gender rating – the process of insurance companies charging women more – is of utmost concern for some, including the National Partnership for Women and Families (NPWF).

“[The ACA] is the greatest advance for women’s health in a generation. Improving health care has long been a priority for women, reflecting their experiences as patients, mothers, and caregivers. Women, on average, have far more contact with the health care system over their lifetimes than do men,” stated NPWF.

Some reported financial benefits for females under the ACA, according to the NPWF, include:

  • Women are gaining more access to affordable healthcare coverage
  • The ACA ensures the prohibition of gender discrimination based on cost
  • The ACA puts an end to “outrageous, predatory practices that have allowed insurers to refuse to cover women”
  • Women are guaranteed preventative services, such as birth control and mammograms
  • The Medicare prescription drug gap will shrink

“The health care needs of women are greater, especially during their reproductive years, and historically women have played a central role in coordinating health care for family members, from spouses and children to aging parents,” NPWF added.

“The ACA will improve women’s access to health insurance coverage, make health care more affordable, and expand benefits — all priorities for women.”

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