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Optimizing specialty practice revenue in the midst of changing payer models

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Tommy Richardson, Chief Technology Officer and SVP of Technology, Nextech

Changes in payer models have placed providers at the front lines of efforts to control healthcare costs. Payer initiatives, combined with a sharp increase in patient self-pay, pose significant challenges to provider revenue cycle management (RCM). These changes are impacting virtually everyone in healthcare.

The increasing popularity of high-deductible health plans, where patients pay lower monthly premiums in exchange for higher out of pocket expenses, has made it difficult for patients to meet their financial obligations. Many now face annual deductibles of $2,600 and maximum annual out-of-pocket expenses of $13,100 for family coverage. As a result, bad debt and collection costs are rising – and the chances of collecting payment are reduced by 62 percent once the patient leaves the office. These changes pose significant challenges to a practice’s RCM – and, if not carefully addressed, can threaten the patient-provider relationship.

In this challenging climate, specialty practices need to find new ways to optimize RCM performance and decrease expenses. Following a few RCM best practices will not only help you collect more revenue at the point of service but also help ensure your practice is patient-centric and keeping the needs of your clients front and center.

Be transparent

Anyone who walks into a major retail store understands exactly what they’re getting for the price. The same can’t be said for all medical practices. Patients who are surprised when they receive bills with charges many times more than what they expected often can’t – or won’t – pay, which can have a devastating impact on a practice’s cash flow. The experience is not only aggravating for patients, but the resulting fallout from financial hardship or collections damages trust, satisfaction and loyalty. Specialty practices, particularly those performing services covered by insurance, such as dermatology and ophthalmology, have an opportunity to serve their own interests and those of their patients by providing cost transparency.

Helping patients understand how much services cost, and what portion insurance covers versus expected out-of-pocket costs, engages patients in their care and arms them with the information they need to make better treatment decisions. Proactively addressing available payment options or plans also boosts transparency while reducing the practice’s exposure to bad debt and collection costs. An EHR partner with an electronic eligibility (e-eligibility) service can help. By automating insurance verification for immediate and accurate identification of coverage – eliminating a time-consuming task for staff – e-eligibility can quickly determine precise patient responsibility before services are rendered, enabling up-front collections. In addition to eliminating potential payment delays and revenue loss associated with post-care patient billing, e-eligibility helps avoid claim rejections due to eligibility verification errors.

Invest in a marketing tool

If you want to attract and retain customers, you need a solid marketing plan in place – no matter what industry you are in. That doesn’t necessarily mean spending a lot of money on scattershot advertising. In fact, with so many new and relatively inexpensive channels, marketing can be easier, and more varied and focused than ever before. Specialty practices, in particular, need to market themselves well, as many times they receive their clients based on referrals.

A marketing tool can help you make better decisions on how to best grow your practice by showing where you’re spending marketing dollars and analyzing the return on investment. Marketing software that integrates with electronic medical records can help you not only see the number of patients referred to your practice but who referred them as well. This integrated module also makes it easy to track care plans, send appointment reminders and follow-up with patients on any new products or service offerings.

Integrate systems for data insights

Having an EMR software that integrates with corresponding PM and billing solutions provides specialty practices with the power to seamlessly streamline their day-to-day processes, from documentation to billing to insurance claims submissions to scheduling patient appointments.

An integrated system with an analytics module will provide better visibility across all areas of the practice and drive strategic decisions for maximizing patient retention and profitability. For example, analytics can be leveraged to identify and track trends in real-time related to inventory, sales and scheduling. Moreover, instead of wading through spreadsheets and reports, data visualization capabilities can give providers an easy to understand picture of practice goals, financial analysis, resource utilization and workflows.


Optimizing business performance

Changing payer models and the rise of healthcare consumerism are challenges that, with the right approach, providers in specialty practices can turn into opportunities to improve financial performance.

To meet patients’ increased demand for transparency and create an overall positive experience of care, providers should take advantage of integrated solutions and leverage tools – such as e-eligibility, marketing software and analytics. Taken together, these best practices can help patients understand their financial responsibility early in the delivery of care as well as increase efficiency in billing and scheduling for specialty practices.

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