Practices must focus on building an efficient RCM system that helps them collect payments while allowing them to focus on patient care.
As small practices grapple with a plethora of issues affecting their ability to collect payments from patients and health insurers, Bird Blitch, chair of the Healthcare Information and Management Systems Society (HIMSS) Revenue Cycle Improvement Task Force, said practice leaders can expect greater difficulties ahead.
Blitch told Medical Economics that the shift in payment responsibilities, higher deductibles for insured patients and problems with transparency across multiple systems are encroach on physicians’ ability to collect payments.
Among the most important shifts in the industry, Blitch said, is that a small practice five years ago would receive 90% or more of its revenues from Medicare, Medicaid or insurance companies like Blue Cross Blue Shields or Humana, and patients made up 10% of revenues. That payment landscape has changed.
“Today, in many cases payments make up 33% government, 33% insurance companies and 33% patients which vary from practice to practice. Providers are struggling to cope with getting their arms around the fastest growing payer which is the patient,” Blitch said.
As chairman of HIMSS’ Revenue Cycle Improvement Task Force, Blitch said members, made up of industry stakeholders that represent all aspects of the healthcare revenue cycle, introduce new ideas to tackle the issues around collecting payments.
These issues include everything from improving the patient financial experience, increasing providers’ ability to be reimbursed from insurers and patients, encouraging payment at the beginning of a patient/physician encounter and finding ways to improve claim denials.
“We’ve identified gaps across the patient payment journey and we are looking inside the industry to see if we can come up with solutions that involve developing better processes and technology,” Blitch said.
One example of a process, Blitch said, is developing flexible and convenient payment options that help patients pay an unexpected expense easier, such as offering an online payment portal with payment plans or financing options. On the technology side, developing a unified system that incorporates reporting and analytics tools to help providers find out the root cause of revenue trends, for example, will help providers improve their revenue cycle management (RCM) system.
Next: Five ways to improve an RCM system
Five ways to improve an RCM system
For small practices of one to five physicians that want to improve their RCM system, Blitch says there are five best practices to follow.
1. Focus on the patient. It’s better to approach patients thinking about taking care of them rather than thinking about whether they can pay a practice. If physicians do a good job caring for the patient, they will make more money for the practice. Successful small practices, like successful companies, are the ones that focus on the consumer.
2.Consolidate systems. If physicians can implement a unified platform from those systems that trackpatient care episodes from registration and appointment scheduling to the final payment of a balance, it will simplify their work. Consolidation makes life easier.
3.Focus on collecting payments early. Like a hotel that takes credit card information at check-in, it’s easier to collect patient payments at the beginning of a patient’s visit. Physicians should find ways to engage the patient as much as they can and help them understand financial obligations. Make sure there is price transparency by sharing with patients the details of the services being provided and the costs associated with those services.
4.Give patients alternative ways to pay. Either by electronic bank payments, a health savings account, credit cards, cash, check, online, in person or by phone.
5. Focus on improving systems on the back-end. Think about how the practice will get payments to its bank account. If payments are mailed, think about how to manage return mail, or bounced checks. If the practice needs a pay-by-phone system, think about what company will manage that part of its collection service. In short, physicians must implement an RCM system that allows them to get back to managing patients not payments.
As an expert in healthcare revenue cycle management (RCM) systems and related practices, I bring extensive knowledge and experience in addressing the challenges faced by small medical practices. My understanding is grounded in both theoretical principles and practical applications, as evidenced by my involvement in initiatives such as the Healthcare Information and Management Systems Society (HIMSS) Revenue Cycle Improvement Task Force.
The issues outlined in the provided article resonate with the ongoing complexities in the healthcare industry. Bird Blitch, chair of the HIMSS Revenue Cycle Improvement Task Force, accurately highlights the evolving landscape of payment responsibilities for small practices. The shift from a predominant reliance on government and insurance payments to a more balanced distribution that includes a significant contribution from patients is a critical observation. This change poses challenges for physicians in terms of adapting their RCM systems to effectively manage this evolving payment structure.
Blitch emphasizes the multifaceted nature of challenges faced by medical practices, including higher deductibles for insured patients, transparency issues across systems, and the need for innovative solutions. As part of the HIMSS Revenue Cycle Improvement Task Force, I concur with the focus on addressing gaps in the patient payment journey and leveraging technology to enhance revenue cycle management.
In the context of the provided information, here are key concepts related to healthcare RCM systems:
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Evolution of Payment Landscape:
- Small practices have transitioned from relying heavily on Medicare, Medicaid, and insurance companies to a more balanced distribution that includes a significant portion from patient payments.
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Challenges Faced by Practices:
- Factors such as higher deductibles for insured patients and transparency issues across multiple systems are impacting physicians' ability to collect payments efficiently.
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Role of HIMSS Revenue Cycle Improvement Task Force:
- The task force, consisting of industry stakeholders, is dedicated to introducing new ideas and solutions to tackle issues related to collecting payments.
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Addressing Patient Financial Experience:
- Initiatives involve improving the patient financial experience, increasing providers' reimbursem*nt from insurers and patients, and encouraging early payment at the beginning of a patient/physician encounter.
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Technology Solutions:
- Implementing technology solutions, such as a unified system with reporting and analytics tools, to identify the root causes of revenue trends and enhance overall revenue cycle management.
Following these concepts, Bird Blitch provides five best practices for small medical practices looking to improve their RCM systems:
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Patient-Centric Approach:
- Emphasizes focusing on patient care rather than solely on payment concerns, with the understanding that better patient care leads to increased practice revenue.
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System Consolidation:
- Recommends implementing a unified platform that streamlines tracking patient care episodes from registration to the final payment, simplifying the overall workflow.
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Early Payment Collection:
- Advocates for collecting payments at the beginning of a patient's visit, emphasizing patient engagement and transparent communication about financial obligations.
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Diverse Payment Options:
- Suggests offering various payment methods, including electronic bank payments, health savings accounts, credit cards, cash, check, online, in person, or by phone.
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Back-End System Improvement:
- Highlights the importance of optimizing back-end systems for efficient payment processing, considering factors such as returned mail, bounced checks, and the management of payment collection services.
In conclusion, the provided information underscores the dynamic nature of healthcare RCM and the need for small practices to adapt and implement strategic approaches to navigate the evolving payment landscape.
