Payers have Evolved, Now it’s Providers’ Turn.

The complexities of insurance make it difficult for practices to get paid quickly. To minimize issues in cash flow, you can use benchmarking to get ahead of problems caused by delayed payment.

 

“The check is in the mail.”

Even with rising premiums that increase patient responsibility, the bulk of fee for service reimbursements still come from payers. In the past few decades, billing a patient directly at the time of service has been replaced with your office staff seeking payment from multiple insurance companies. And as dealing insurance has become increasingly more complex, so too has the opportunity for a claim to be rejected and your practice to go unpaid.

Understand that insurance companies are like any other financial entity, any gap between cash inflows and outflows presents an opportunity to invest for short-term interest or drive additional margins to report to investors. Ultimately, payers benefit from not paying you quickly.

This can cause problems, as any delay or loss in payment can present challenges in managing the revenue cycle of your practice. At a minimum, delays in payment can make it difficult to accurately predict cash flow. At its worst, it creates stress over just keeping the lights on and can potentially lead to burnout. Finding ways to mitigate any delays or lost payments from payers requires an understanding of what behaviors or patterns to look with payers.

 

Benchmarking levels the playing field. 

Trying to identify a pattern of delayed payments from a specific payer can be a daunting and time-consuming task. This can be further complicated if you’re sourcing this information from your EHR/EPM system, which means sorting through massive amounts of often poorly organized data. Thankfully, benchmarking can provide a more pragmatic approach to tackling all of this data and the easiest place to start is against your practice’s history.

 

Benchmarking against yourself

A key metric to look for patterns in payer behavior is in your denials. For every 100 insurance claims you submit, it’s likely only 85-90 will be adjudicated, with the rest getting delayed or even denied. Identifying variations in denials throughout your practice’s history will help you spot trends across different offices, payers, or procedures that indicate a payer rule change. This should equip you with the necessary information to prevent further denials for the same issue.

Another important metric to track internally is new patient growth. While new patient growth won’t uncover patterns in payer behavior, it will indicate your practice’s ability to weather ongoing rule changes that could affect your bottom line. Most practices will typically see their patient attrition grow each year due the standard excuses to reaching end of life. While seeing additional patients each day could mean an increased workload for your practice and staff, your practice must bring in new patients to stay afloat. 

Armed with this information you practice has the opportunity to not only make up for losses incurred from denials and payer rule changes, but a viable path towards growth. 

 

Next steps.

Dealing with insurance is a consequence of being a healthcare provider. While insurance rules continue to evolve and the gap between treatment and payment will likely never be reduced, proper benchmarking can give practices the opportunity to still thrive and grow.

If you would like to learn more about how benchmarking can help your practice grow, you can download our whitepaper: Shining a Spotlight on Insurance: Four ways your practice is losing money if you aren’t benchmarking.

If you have any questions about benchmarking or want to learn how we can help your practice you can call (301) 990-3995 or email us at info@hpiinc.com.

Reversing the Burnout Crisis: Helping Physicians Be Physicians Again

In the rapid transition from fee-for-service to value-based health care, physicians are working harder than ever. They’re increasingly struggling to achieve better patient outcomes and lower cost while managing the financial health of their practices.  Administrative burdens are rapidly eclipsing the joys of patient care and relationships.

The result is an epidemic of physician burnout that’s taking a huge toll.

Here are some recent statistics:

  • 78 Percent of physicians say they have experienced burnout.—Physicians Foundation 2018 Physician Survey
  • Physician burnout rates have risen from 30 to almost 60 percent in some specialties.—AMA
  • 80 Percent of physicians report being at full capacity or overextended.—Physicians Foundation 2018 Physician Survey
  • 33 Percent of physicians say depressive feelings impact their relations with patients.—Medscape National Physician Burnout & Depression Report 2018
  • Physicians spend at least 44 percent of their time on clerical and documentation tasks, including 86 minutes every day, after hours, on electronic health records.— AMA 2017 Research Study
Burnout Affects Doctors and Patients

High burnout rates mean increased occurrences of mental health issues for physicians, including disproportionate rates of depression, substance abuse and suicide.  All of which clearly affect patient care.

Burnout can impair physicians’ attention and decision-making.  They may also feel less empathetic and engaged in patient outcomes.

Burnout also means many doctors are leaving medicine mid-career, which, among other things, is negatively affecting patients, who have to start over with new providers. Many other physicians are cutting back on hours, making it harder for patients to schedule appointments with the doctors they still have.

While the root cause of physician burnout is complex, increasing workload and financial strain are clearly primary contributors.  So, the question becomes how to control—then reverse—the trend and breathe new life into doctors and the field of medicine?

According to Medscape’s National Physician Burnout & Depression Report 2018, to alleviate burnout, 56 percent of physicians suggested fewer bureaucratic tasks and 39 percent suggested fewer hours spent working. About one-third of physicians surveyed for the report suggested more money and a more manageable work schedule.

That means, to get it right takes:

  • A focus on patients, not paperwork
  • Driving better health outcomes
  • Streamlining clinical and administrative procedures
  • Improving margins and profitability
  • Empowering physicians to get back to what they love

Health care organizations need strategic partners to help them get there though.  At HP, we believe technology, data and a physician’s perspective can deliver solutions that benefit all stakeholders, including providers, patients and practices.

Managing the complicated administrative burdens of more payors, varying standards and an endless stream of government regulations has made physician burnout an occupational crisis in health care today.  Since 2004, HP has been helping healthcare organizations and their patients thrive while allowing physicians to get back to what’s most important.

HP makes technology the solution, not the cause.  Our holistic approach delivers on a promise to improve the well-being of physicians, patients and healthcare practices.  We believe with the right technology and transformational partner, moving from fee-for-service to value-based care can make sense for everyone and help.

If you’re ready to address burnout and get back to the joys of practicing medicine—and your life, contact us.

How to Succeed in 2019 with Better Revenue Cycle Management

It’s 2018, and the business of healthcare has never been more complicated. But that’s about to change. And not for the better.

With rising deductibles and tighter payer reimbursements, 2019 promises to be even more challenging for providers working to deliver positive health care experiences while improving the bottom line.  Managing the money tied to patient encounters at each step of the process is complex.  That’s why, in today’s health care economy, revenue cycle management (RCM) is crucial.  Getting it right is essential to the financial viability of any health care organization.

In 2019 and beyond, when patients are increasingly paying more of their health care expenses out-of-pocket and insurers are requiring more data, how can practices improve their RCM?

The answer is an approach that includes a combination of:  improvements to internal processes; deployment of sophisticated, customized technology tools; and strategic partners with the right expertise.

Let’s take a closer look at why RCM is increasingly tripping up providers and how to right the ship in the year ahead.

Trending toward More Challenges, Not Fewer

Consumer trends such as high-deductible plans are resulting in a shift in payment obligations. These plans mean patients are faced with paying a greater portion of their healthcare expenses out-of-pocket.  As patients see out-of-pocket costs rise, they are facing more difficulty paying, or paying on time.  For providers, that translates into greater challenges recovering payment from patients.

Moving from a fee-for-service to value-based approach also presents RCM challenges as providers face navigating through ever-changing insurer compliance requirements.  This means time- and resource-intensive processes require the highest levels of quality to assure reimbursement.

With these constant changes and soaring complexity, internal staff’s dwindling time hinders the practices’ ability to recover maximum reimbursement.  These challenges, combined with more physician burnout and lack of internal expertise, keep providers from focusing on RCM and the changes necessary to improve it.  The result: money is left on the table.  And usually a lot.

Data Matters

For already over-burdened physicians and staff trying to manage revenue cycles, mistakes are made when decisions are driven by limited or no data.  For most health care organizations, the only available data comes from practice management systems, which aren’t comprehensive enough to be of real value.

It’s essential for practices to have sufficient data and a clear understanding of what it means. Lack of granular insights makes it nearly impossible to make effective strategic decisions to effectively manage and ultimately drive revenue.

Improve Processes

Many billing cycle problems can be resolved before the patient ever receives care.  This is where an expert can provide value developing, training staff on, and executing pre-visit procedural best practices such as registering patients, entering demographic information, verifying and scheduling appointments, and clearly explaining payment policies and procedures.

Improved billing and collections—from claims submission to final reimbursement—must be examined and optimized.  Usually this happens most efficiently with a trusted strategic partner that brings deep knowledge of modern health care practice realities, as well as technology expertise and tools.

Bringing It All Together

Patient and insurer trends, data, technology and back-end processes factor heavily into a practice’s RCM success.  When protocols and processes are not thoughtfully considered and implemented, a ripple effect can significantly delay reimbursements, lower margins and negatively impact the bottom line.  Identifying and addressing the challenges is no longer an options but a requirement for health care organizations to thrive now and into the future.

A Three-Point Checklist for Choosing a Technology Solutions Partner

Let’s talk about the financial health of your practice.  First, though, let’s talk about smart health care.

According to Deloitte’s 2018 Global Health Care Outlook Report: The Evolution of Smart Health Care, smart health care requires “the correct individuals do the correct work.”  The report cites the top issue in health care today as: “creating a positive margin in an uncertain and changing health economy.”

So, what does that mean for your practice?

Providers don’t go into health care because they want to manage time-consuming administrative tasks.  Nor do they want to unravel the financial mysteries of achieving the highest margins in today’s world of health care value over volume.  That’s why, amid evolving delivery models and complex government regulations, it’s important to find partners who do that work for you.

Freeing up provider time to focus on delivering the optimal patient experience means engaging the right experts to take on administrative burdens.  But choosing the right solutions partner can be as complicated as navigating an evolving health care marketplace.  Fortunately, it can also be a positive game-changer for you, your patients and the financial health of your business.

Here’s a checklist of considerations to help guide your search.

1. Consider Your Comprehensive Requirements.

The first step in the selection process is to assess your requirements: You should identify high-priority needs and the features and services that will meet those needs.

Comprehensive solutions and broader expertise from a single technology vendor make good sense if your needs extend beyond just billing software, for example. Significant cost and administrative efficiencies come when technology solutions are integrated, and partner expertise is broad.  Streamlining efficiencies and reducing administrative costs through a holistic approach to technology solutions, such as integrated revenue management and practice optimization, not only improve the quality of life for physicians but also the overall health care experience.

2. Quality First.

Trust is paramount.Ask for references from prospective technology partners, understand and assess not only expertise but depth of experience.  What do their current engagements involve and are they prepared to address wide-ranging challenges?

Consider the importance of working with experts who not only bring technology know-how, but also practical, first-hand health care expertise.  This will mean high standards in the areas of security and patient-provider confidentiality.

3. Think Outside Out-of-the-Box.

Out-of-the-box, single platform solutions often won’t meet the specific needs of your practice. Maximized profitability often requires a variety of customizable solutions and services.

Your practice may benefit from a partner that is not only an expert advisor, but also acts as your workflow and compliance gatekeeper, delivering insights to address the unique challenges of your practice.  Does the nature of your practice require technology-enabled solutions that fully integrate with your existing software systems to assist in addressing unique business challenges?  Then there is significant advantage to a technology solutions provider that is system-agnostic and will deliver a customized approach that out-of-box software can’t.

Engaging the best technology solutions partner for your organization is more than a matter of healthy business efficiencies.  For organizations operating in today’s complex health care economy, smart choices can be a lifeline. So, take the time to choose wisely.