Revenue Cycle Management

Transcription

1 UNITED COLLECTION BUREAU, INC Southwyck Blvd. Toledo, OH ucbinc.com The Business Case for Outsourcing Revenue Cycle Management Getting reimbursed for services rendered is more challenging for healthcare organizations than ever before. The healthcare revenue cycle system has been further complicated by new legislation and changing regulations. Health systems, hospitals, clinics, and independent practices are all experiencing a financial crunch as the result of decreased revenues a side effect of evolving healthcare reimbursement models and market trends. To get paid quickly and accurately, organizations are now looking to work with outside partners to support their revenue cycle management processes. According to a report published by MicroMarket Monitor, the market for revenue cycle management consulting and outsourcing is steadily expanding 1. The revenue cycle management market is projected to grow at a compound annual rate of 7.2 percent through The primary reason driving the decision of organizations to work with third-party revenue cycle management partner is threefold: to improve financial performance, simplify To get paid quickly and accurately, organizations are now looking to work with outside partners to support their revenue cycle management processes. processes, and leverage additional resources. For healthcare organizations and practices seeking to enhance profits, streamline efficiencies, and lower costs, outsourcing revenue cycle management processes makes good business sense. Revenue Cycle Management Processes in Healthcare An effective strategy plays an important role in protecting the profitability of healthcare organizations and providers. Revenue cycle management (RCM) encompasses specific administrative procedures that ensure health systems, hospitals, clinics, and independent practices will be paid for rendering services. The complete healthcare revenue cycle process includes confirming patient eligibility, collecting co-pays, coding claims, tracking claims, collecting payments, reconciling bad debt, and appealing denied claims. Page 1 of 6

2 Because healthcare RCM processes are generally modular in execution, several components can be partially or even fully outsourced. Some healthcare organizations and providers opt to manage their revenue cycle management internally, but seek guidance from a consulting firm in redesigning their system to enhance administrative efficiencies and bill collection results. Still others elect to outsource specific functions, such as self-pay accounts receivables. A small minority of providers choose to outsource their revenue cycle management entirely to an outside partner. The identification of deficiencies within the current system enable healthcare organizations and providers determine the extent of necessary engagement of an RCM. Because healthcare RCM processes are generally modular in execution, several components can be partially or even fully outsourced. By choosing the right revenue cycle management partner, health providers can improve up-front patient payments and better manage payer claim and payment processes to ensure their long-term financial viability. The outsourcing of RCM functions also represents a cost-savings measure for healthcare organizations and providers since they only need to pay the partner for the specific services contracted. This strategy helps organizations save money, since engagement with an RCM partner means they don t need to recruit, train, and compensate full-time staff members to perform RCM functions. Current Challenges in Healthcare Revenue Cycle Management As the industry continues to make the transition from a fee-for-service model to a valuebased care model, healthcare organizations and providers are under additional pressure to achieve the so-called Triple Aim. The three goals of this initiative as set forth by the Institute for Healthcare Improvement (IHI) are to enhance patient care, improve the health of populations, and reduce the cost of care 2. Identifying strategies to deal with both a declining cash flow and a rising rate of bad debt are top-of-mind issues for C-suite healthcare executives and private practice physicians. These challenges, coupled with new regulatory requirements surrounding Meaningful Use and ICD-10, as well as the spurt in at-risk and shared-risk payment plans, make it imperative for healthcare organizations to optimize their revenue cycle processes sooner rather than later. Health providers also have the responsibility of educating their patients about the complicated payment options that have emerged as a result of healthcare reform legislation. This has led to new models of healthcare delivery and reimbursement, such as accountable care organizations (ACOs) and bundled payments. There is also a financial incentive for healthcare organizations and providers to streamline efficiencies Page 2 of 6

3 in order to be effective in collecting current and outstanding payments from patients. Denied or rejected claims can add 60 to 90 days to the payment process, and restricts the ability of healthcare organizations to effectively manage cash flow. This is where partnering with an RCM vendor can add value to an organization. Before making the decision to outsource mission-critical revenue cycle functions, organizations should first conduct an internal evaluation of their current resources and identify system deficiencies that could be resolved with the assistance of an experienced and trusted revenue cycle management partner. The right RCM partner should have topof-the-line technology solutions to support each function across the entire revenue cycle, including patient scheduling and registration, eligibility verification, claims processing and follow-up, bad debt recovery, and more. United Collection Bureau, Inc. (UCB) delivers a full suite of revenue cycle management solutions to health systems, hospitals, clinics, and independent practices across the country. UCB s customized and flexible product and service offerings help clients meet their RCM performance goals in the following areas: Patient Scheduling and Registration Patient scheduling and registration are two activities that healthcare organizations and providers can leverage to expedite payment. As a mature RCM partner, UCB can benefit the scheduling and registering procedures of the client s patients in a timely and professional manner, while tending to patient insurance information and collecting payments. UCB s services streamline administrative efficiencies and enable physicians to maximize the time spent providing care to patients. Eligibility Verification The first step on the road to payer reimbursement is the verification of the patient s eligibility for insurance coverage. Coverage verification at the point of service gives the client the first opportunity to collect self-pay balances that remain after insurance reimbursement. UCB provides eligibility verification services that assist patients throughout each step of the benefits verification process to ensure fast and accurate reimbursement. UCB also helps health systems, hospitals, clinics, and independent practices collect government and community reimbursement for uncompensated medical expenses. UCB provides eligibility verification services that assist patients throughout each step of the benefits verification process to ensure fast and accurate reimbursement. Page 3 of 6

4 Claims Processing and Follow-Up Many payers offer mechanisms to health providers for submitting claims directly. These methods include the ability to send multiple electronic claims in a single file or in batches. One revenue cycle management survey revealed that 31 percent of hospitals have initial denials of greater than 10 percent 3. UCB provides services to confirm that insurance claims are submitted correctly the first time, which reduces the number of outstanding accounts receivables and improves cash flow. UCB acts as an intermediary for clients by contacting insurance companies, verifying third-party payer coverage, initiating the pre-certification process, reporting co-pays and/ or out-of-network charges to the facility financial counselor, filing claims within time limits set by payers, and documenting the client s system. As an experienced and trusted RCM partner, UCB tracks and monitors the status of all claims after they have been submitted to payers. In addition, UCB offers services to clean up any backlog of aged accounts and for legacy system work-outs at system conversion. Bad Debt Recovery Often insurance denials go uncorrected until they re placed with a bad debt agency, which ultimately adds to the cost of collections for healthcare organizations and practices. UCB provides services that offer optimal return on bad debt accounts, while minimizing patient complaints. UCB s strategic use of technology and adaptable resources has a positive impact on their clients bottom line. UCB leverages its proprietary analytics software platform, isolutions, with presumptive charity and propensity-to-pay functions to determine how much patients can pay without fear of financial duress. Along with customizable options for bad debt collection, UCB offers optional legal services and solutions. RCM Outsourcing Makes Dollars and Sense Within the industry, the strategy of outsourcing of revenue cycle management has grown quickly in popularity and acceptance. The 2015 Black Book Report estimates that 95 percent of independent providers view the outsourcing of some or all revenue cycle management processes as a sensible solution 4. Seventy-three percent of medical group practices working with consultants on accountable care reimbursement strategies are considering outsourcing RCM in 2016 as they evaluate technology vendors. Ninety-five percent of independent providers view the outsourcing of some or all revenue cycle management processes as a sensible solution. Page 4 of 6

5 Eighty-three percent of hospitals now outsource some accounts receivables and collections. The key to gaining the most benefit from revenue cycle management outsourcing is to work with an RCM partner with a proven track record of providing solutions and services that maximize reimbursements, decrease denials, and increase profitability. Since 1959, UCB has been at the forefront of technological and regulatory excellence in the industry. UCB is the developer of the isolutions platform, a robust and powerful analytical tool designed to help healthcare organizations increase profits, improve operational efficiency, and reduce operating costs. The isolutions platform integrates seamlessly into the existing revenue cycle systems of hospitals, clinics, and independent providers with minimum IT involvement. UCB s customized, client-driven workflow begins with seamless software integration and ends with a process that improves patient engagement and accelerates cash collection for clients. References html#src=whatech Financial Leadership Council Revenue Cycle Survey. The Advisory Board Company Page 5 of 6

6 ucbinc.com UCB has a 50+ year history of commitment and dedication to providing advocacy to your consumers. Our reputation is built on trust, quality, and performance in every relationship. The content contained in these paper materials are presented as a courtesy for educational, general, and informational purposes only. The contents are not intended to serve as legal or other advice and should not be received as legal or other advice. Page 6 of 6