Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Revenue Uncertainty a Major Challenge for Clinicians

By Ryan Mcaskill

In an interview, Phyllis Wright of Lake Shore OB/GYN explains the challenges of clinical revenue cycle management.

- Every clinic faces the challenge of turning a profit. With evolving technology and a growing focus on quality over quantity, many clinics are facing tough decisions about the future.

In an interview with, Phyllis Wright, the Office Manager at Lake Shore OB/GYN spoke about the revenue cycle management challenges that the clinic faces. She joked that revenue cycle is not something magical. It is critical because it helps pay the bills and provide care for patients.

To help improve the process, earlier this year Lake Shore adopted Greenway to help improve its financials and ready itself for ICD-10. According to Wright, it was the best product from an OB clinical standpoint in the marketplace. Greenway was chosen after a year of searching and vetting 18 different solutions.

According to Wright, the biggest challenge that lake Shore runs into is consistent reimbursement. Things can be submitted the same way for five years and all of a sudden its submitted and not paid and it becomes a challenge to figure out why. Any change can suddenly create a disconnect.

“You have to be an expert in patient care as well as coding,” Wright said.

She went on to say that consistency in coding is a must. Lake Shore has created templates to map out diagnosis codes and help catch anything that may pop up before it becomes a major problem. This also helps clinics stay ahead of things so claims can go through quickly instead of being bounced back and starting an internal run around to get questions answered and reverse the process.

The landscape is also changing because of the Affordable Care Act, though how is still up in the air.

“I don’t know if we really know the answer to that yet because things are just different,” Wright said. “Co-pays are no longer required for annual visits, patients with higher deductibles are an issue and consumers need to understand what health care product they have and what their responsibility is.”

She added that it is becoming a consumer based world. In the past, patients would trust a doctor and second opinions were only used for major things. The doctor/patient relationship use to be sacred and that is something that is fading away with a consumer centric system.

There are other concerns for the future, most noticeable when it comes to consistency.
“The uncertainty is by far much greater and much more wide felt in the health industry,” Wright said. “Before you use to say this is how it is and it will change a little bit and that has completely changed. Now its we don’t know what’s going to happen, we don’t know how much money we are going to make, we don’t know if patients are going to pay us. This is much more uncertainty, it’s a constant struggle. There is really nothing we can do about it.”

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