Each year brings its own unique set of challenges. Since you’ll be plenty busy focusing on your own business health in 2014, we took the time to gather some insights from our leaders who deal with hundreds, if not thousands, of businesses like yours every day, and who have a slightly different vantage point. Here’s what they had to say.
“Physicians and medical business professionals will face increased complexity in collecting revenue in 2014 due to a combination of factors. As consumers participate in new insurance exchanges and deal with different coverage parameters, they will arrive at provider offices uncertain about their benefits coverage. It may also be difficult for the provider to get a clear answer from the exchange—or give a clear explanation to the patient. We know this scenario makes collecting payment up-front (and ultimately, collecting on unpaid balances) more difficult. Add to that more complex contracts under new value-based payment models and the growing popularity of plan designs with higher out-of-pocket requirements for patients, and physicians are being dealt a triple-whammy on revenue collection. These factors contribute to significant revenue risk for providers.
“In order to mitigate these risks and thrive in a changing environment, providers will need enhanced tools and processes for engaging both payers and patients. The best solutions should increase automation, reduce complexity and provide analytics insights to help business professionals manage risks and opportunities.”
– Ryan Miller, senior vice president of strategy and corporate development
“ICD-10 will take center stage this year. Even the best-prepared providers are concerned about business disruption as the industry adopts the new code set. Not only do billers and coders have to learn how to apply the expanded code set, but physicians have to provide significantly more detailed documentation to their staff in order to do that work. This alone can be a big process change for many physicians. And then there’s the issue of collective readiness – even if providers are prepared, a successful migration will require their payers, practice management systems and clearinghouses to all be ready. We see that preparing for this change will consume a significant amount of provider energy and resources as the Oct. 1 deadline approaches.
“Adding to this disruption are the new government health exchanges. They will introduce new challenges for providers, some of which we can foresee and some we can’t. We assume that more people will be insured, but it’s unknown whether these patients will be more or less likely to pay their premiums and remain insured than the existing insured population. Providers could end up with higher patient collections due to dropped or inconsistent coverage, adding further complexity to collections efforts.”
– Dawn Ratcliff, director of field services and support
“Medicare payment reform is gaining traction, and will require physicians and medical business professionals to adopt billing technology that is able to understand these new models. To meet this need, the more sophisticated revenue cycle management companies are staying atop of trends by developing and refining systems to prepare for the growth of accountable care organizations, patient-centered medical homes, bundled payments and other value based-payment models. While still a ways off, new revenue cycle management solutions will ultimately need to integrate with an existing—and already complex—ecosystem of electronic medical records, healthcare information exchanges, practice management systems and robust analytics engines.
“Meanwhile, market forces such as the growth of high-deductible health plans will contribute to a growing trend of consumer-driven health care. With greater financial responsibility of their health care choices, individuals are demanding increased transparency into options and cost. With that, patient satisfaction and engagement will become even more critical for physicians and other providers of care.”
– Brian Kagel, director of research