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

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What is the Future of Revenue Cycle Management?

By Jacqueline DiChiara

- A crystal ball showing the future of revenue cycle management depicts a spotlight brightly shining down upon an individual wearing three different hats – those of the healthcare consumer, patient, and payer.

This increased focus will continue to dominate revenue cycle management in the foreseeable future and will impact hospitals, physicians’ offices, and providers, according to David Josephs, Senior Vice President for Healthcare Solutions First Data Corporation.

Josephs recently spoke with RevCycleIntelligence.com to provide more depth and a more thorough perspective regarding where revenue cycle management is headed.

With malleable relationships come new challenges that require addressing.

“With the rise of the exchanges, with the growth of the individual market, payers have to focus on individuals as purchasers of healthcare and healthcare coverage in ways that they maybe haven’t focused as intensely in the past,” explains Josephs.

READ MORE: Patient Financial Responsibility Not Owed Top Medical Debt Issue

Revenue cycle management’s future is now fully entwined with the idea of a more accountable consumer. Payers are taking action to ensure the minimization of financial glitches.

“As individuals continue to have more responsibility for both the larger percentage and larger absolute value of their healthcare dollar, we’re going to see payers continue to try to help doctors and hospitals and providers address the challenges associated with increased patient responsibility,” Josephs maintains.

The crystal ball of revenue cycle management also depicts a shattering of the expected archetype to reveal more creative alternatives.

The growth of high deductible health plans means a more aggressive focus on consumer payments as creative business models begin to emerge around providers, says Josephs.

“It’s possible that high deductibles and increased patient responsibility may create opportunities for spot pricing in the provider market,” says Josephs.

READ MORE: Key Ways to Start A Hospital Revenue Cycle Turnaround Process

This includes the incorporation of daily deals or an attempt to drive volume during a practice’s slack times when patients are slow to come through the door, explains Josephs.

“If I need to collect from you anyway, if I can establish price for you in the marketplace and know what that price is, it may make my life easier,” confirms Josephs.

The crystal ball depicting a creative approach to the healthcare industry involves insurers, health savings accounts (HSAs), and flexible spending accounts (FSAs).

“In addition to linking to HSAs or FSAs, we will see insurers try to become more nimble and creative about ways they can help providers manage that burden.”

As insurers continuously attempt to ease the providers’ burdens associated with amassed patient responsibility, they will aim for efficiency when estimating patient responsibility in advance or close to an encounter, says Josephs.

READ MORE: Is Radiation Overuse Contributing to Higher Healthcare Costs?

“Insurers are going to get creative and see if they can become the source of collection or funds of behalf of the patient to the providers,” Josephs states. “Insurers with their own HSA programs are potentially able to suppress those claims straight through and treat the HSA as if it’s simply another funding account to pay a claim and pay the provider which reduces the providers’ need to pursue and collect from the individual.”

By simply zooming in onto the consumer, such as specifically honing in on the need to know as close to the time of service or as far as possible in advance of service what the consumer owes a provider is says Josephs.

A creative approach to healthcare means physicians might incorporate newfangled approaches to widely accepted models as marketplace pricing involves more daily deals.

“Doctors will say I can’t go above my contracted rates, but I can potentially go below my contracted rates,” Josephs explains.

Fortunately, ensuring financial stability and control does not entail the passive twiddling of thumbs to see where the future of the healthcare industry is headed next. Reliable methods can be established immediately to ensure reliable payments, says Josephs.

Knowing what an individual owes as close to the time of service as possible, for instance, is key to ensure the seamless execution of reliable financial activity.

More Methods of Payment Mean Revenue Cycle Hindrances

A closer examination of the crystal ball reveals loss of revenue when challenges with the adoption of new technology hinder revenue capture.

The days of pulling out a checkbook are long gone. The healthcare industry will not be immune from how consumers desire to pay, says Josephs.

However, with a variety of channels, form factors, and entry ways to capture payment information – HSA cards, FSA card, EMV chip cards, healthcare specific cards, personal checking accounts, debit accounts, credit cards, virtual wallets, Apple Pay, provider-based payments, online banking portal transactions, etc. – hospitals, doctors, and insurance companies must make sure enhanced security around this financial information, says Josephs.

“Providers and insurance companies are going to have to capture and store more personal financial information,” states Josephs. “They will require enhanced financial information protection.”

Consumers are going to learn new behaviors from their regular interactions with merchants about how they want to pay, says Josephs.

“If you adjust to the way people want to pay you, it makes your ability to collect and accept payment easier,” maintains Josephs.

Returning to the crystal ball one last time, the spotlight now focuses on the art of engagement as a means of solving additional problems.

One of the greatest challenges providers face when collecting from patients is establishing a relationship with the patient that both reinforces the expectation that the patient is going to have to pay and establishes processes that make that as seamless as possible, says Josephs.

Financial incentives will continue to simultaneously evolve as more tools emerge within the market such as those that are health plan driven, provider driven, agnostic party driven or third party driven says Josephs. The aim of such incentives is to help consumers better shop, help providers attract volume, and allow employers to encourage their employees to seek the most appropriate care in the most appropriate setting, says Josephs.

“The wellness incentive trend can expand significantly beyond taking a wellness assessment and having labs drawn once a year into much more dynamic, tactical, episodic care-driven incentives from where it is right now,” says Josephs.

An awareness, recognition, and acknowledgement of the trifold individual with three hats means a successful revenue cycle management and a stunning future ahead for the healthcare industry at large.

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