At Availity, we often hear from health care providers about the troubles they face in managing their revenue cycle – after all, if they are looking for or using a revenue cycle management system, they are often trying to resolve a revenue challenge. But in recent years, the pressures appear to be mounting, and we hear things like this: “Patients can’t afford to pay their medical bills. If we don’t do something soon, we won’t be able to stay in practice.”

Those were the words of a real primary care physician in Texas who manages a rural practice with his father, and was traveling nearly 100 miles a day to attend graduate level classes on the health care system. He said he was trying to learn what he could do to stop the financial hemorrhage his practice was experiencing, and hoped what he learned could help keep the family practice in business.

His plight appears to be increasingly common. A recent New York Times article1 suggests that changes in consumer behavior stemming from high-deductible health plans may be putting more of the physician revenue stream at risk. In addition to an increase in unpaid bills from patients, many of which are now responsible for a greater percentage of their medical costs, we’re beginning to see a growing number of consumers seeking care in non-traditional settings, reducing opportunities for new revenue among primary care providers.

In a survey of health care consumers by the Deloitte Center for Health Solutions2, 19 percent of respondents said they used a walk-in clinic or other retail clinic for nonemergency care; this is higher than in previous years (15 percent in 2010 and 13 percent in 2009, respectively). Additionally, 13 percent consulted an herbalist, homeopath, chiropractor, or other alternative health care practitioner.

Together, these trends mean less revenue coming in and harder-to-collect receivables on the back end, and they are only two trends wearing on physician revenue.

How you can protect your practice

While there are certainly trends and behaviors beyond your control, changes in the market don’t mean your practice is doomed. Instead, focus on those areas you can control, like reducing denials and improving clean claim rates that can allow you to recover more revenue. You can even go a step further and automate these functions with a revenue cycle management system, which can reduce administrative costs and ultimately allow you to increase income.

Effective revenue cycle management is clearly becoming increasingly important. But if the concept of revenue cycle management is a foreign one, as it was to the rural Texas physician, just focus on a few key areas where changes can have the biggest impact.

When you’re looking for a revenue cycle management system, remember these three areas:

  • Automation: Automation of key tasks such as eligibility verification, claim status checks and remittance management reduces manual intervention while improving the likelihood that your claims will be paid, effectively doubling the benefit to your practice.
  • Clean claims: Claim scrubbing capabilities are key to reducing back-end denials. A good revenue cycle management system should check for a variety of edits, including payer-specific edits for your region and payer mix, so your billing manager doesn’t have to.
  • Service: If you are in the position of needing a revenue cycle management system, you will want and need the guidance of a strong partner to share best practices, provide consultation and ensure you get the best bang for your buck.

 

1 Lowrey, Annie. In Hopeful Sign, Health Spending Is Flattening Out . New York Times, 2012. Web.

2 Keckley, PhD, Paul, Sheryl Coughlin, PhD, MHA, and Leslie Korenda, MPH. Primary Care: Today and Tomorrow . Deloitte Center for Health Solutions, 2011. eBook.