Some sobering numbers surfaced from a 2016 Black Book Market research survey. They surveyed 2,000 independent physicians and 200 hospital-based physicians. The results suggested that 90% or nine in ten small, independent practices are financially and technically challenged to implement value-driven care for patients.
What exactly is value-driven care? This model is driven by delivering the highest quality of care, cost effectively to patients. It is also centered on patient outcomes. This is far different than the traditional volume-based payment, also known as fee-for-service payments.
Aligning and integrating your clinical and billing workflow processes can achieve operational efficiency in meeting new reimbursement challenges.
Prevent Claim Denials
Your current practice management software technology may lack a robust denial management feature and effective analytical tools for future prevention. A recent American Medical Association (AMA) insurer report card indicated that average claim denial rates are up to 2.64% for major private payers. Furthermore, the average dollar amount per claim for complex denials is $5,418.00. Industry statistics also show that reworking a claim costs an average of $25.00 and up to 60% of denied claims are never worked.
Because local payer guidelines edit the insurer's national coding and guidelines, aligning your workflows with the various payer requirements can achieve better claims reimbursement. To do this effectively, you must have a handle on the origination of your highest denial buckets and by which payers. Armed with this information, you can then set software edits to flag potential denials before claim submission. Ensure your edits are maintained, functioning, and improving your clean claims and days to pay rate.
Data gleaned and categorized can also help support your contract negotiations. For example, there may be a contract requirement denial pattern that is routinely overturned on appeal.
Make it Easy to Receive Patient Payments
Does your patient understand what your payment expectations are? How is this expectation carried out by your front and back office teams?
As your office knows, your patients have absorbed more medical expense cost than ever before. A major change is due to health insurance deductibles and premiums that have risen 40% since 2010 (from a 2016 Kaiser Family Foundation study). Another cause is how payers are reimbursing - or not. It's critical patient eligibility, financial and clinical information is readily available and can be accessed at the right time by the folks who will benefit the most. Integration of the entire patient cycle is key to ensuring a profitable and sustainable revenue flow.
Another area to make it easy to do business with your practice is in how you accept payments. In fact, a McKinsey study found that 66% of consumers polled expressed interest in paying doctors via mobile and 75% of consumers pay household bills online. Yet, 87% of consumers report that they receive health care bills in the mail. A number of service providers are evolving who meet strict patient privacy protection guidelines that can help you bridge the gap in this area. Your current provider may also provide a service that will have a return on investment. It's worth the time investment to discover what will fit with your environment.
How to Better Meet Patient Payment Expectations
The easier you make it to pay, the more likely it is that you will receive on-time payments. This may mean creating updated payment policies, more flexible payment plan options and simply meeting your patients where they are financially with a plan to adjust payments as their finances improve. The bottom line is on-time payments mean less labor in follow up, less bad debt, and better, consistent cash flow for your practice.