The revenue cycle has many facets, but, contrary to popular belief, not all of them are in the hands of the service provider. Other factors commonly precipitate changes, but often people overlook this. Some of the recent changes in health insurance and billing practices have made working in this industry even more difficult than it already way. Below are the most common drivers challenging providers for revenue cycle management.

In the short-term, the Affordable Care Act (ACA) will probably result in an influx of patients. Removing the restrictions of pre-existing conditions means that many of those newly insured patients may be complex the first time they step through your door. The influx of patients should mean more money toward your practice, but it also will mean more time spent on billing and longer appointment times as you get to know new patients that may not have been to a doctor for a long time. The sudden rise of services covered initially also seems like a good thing for providers, but there is concern that the long-term result will be reduced payment rates or changing payment models, such as bundled care and increased capitation.  

The adoption of ICD-10 coding will bring US providers current with what the rest of the world is doing and offers better data to both providers and insurers. Unfortunately, it also means someone in the office needs to learn the new coding system. In addition, mistakes in the learning process could create delays in insurance processing.

The new HIPAA 5010 is just some additions to the previous HIPAA laws. On the surface, that seems pretty benign, but it changes the electronic data interchange procedures to increase the privacy of the patient’s health data and creates changes in the way data can be handled in the office and exchanged with health insurers.

Many insurance companies are increasing co-payments for services. This will result in more cases where you will either need to insist on copay before service is performed or may need to bill patients who didn’t bring their copay with them. It could also result in more bounced checks from low-income patients if they need to pay the copay because they need the visit but don’t actually have the money. These changes could increase your accounts receivable or eventually translate into bad debt that your practice has to write off.  

Consumer-driven health plans can lead to patients who feel empowered by their new choices will shop for medical providers like they choose their plumbers and nail technicians. They will be looking for value for their money and good customer service. This can mean that they’ll expect more of a doctor’s time or might not give as much respect to their medical opinion. Others may avoid medical care entirely as they struggle to understand their new policy or if they cannot afford the prices they have to pay since less is covered by the insurance.

Many of the consumer-driven plans have high deductibles and introduce new parties into the billing process and revenue cycle. With a deductible, the office usually has to first bill the insurance, then see how much the patient is required to pay and bill the patient for that amount. This, like higher copays, can lead to more money in collections. These high deductible policies often come with health savings accounts. Sometimes those pay providers directly, but other times they pay the patient, and the patient is then responsible for sending the money to the provider. In low-income patients, that check can prove too tempting and might not reach you in a timely manner. Even in honest patients who will pay their deductibles, they may have more concerns about treatment and cost to discuss with you if they know they have to pay more of the bill. Whether it’s changing a prescription or trying a less expensive treatment first, that can turn medical decision making into a question of money more than the best treatment. This in turn can cause issues explaining to the insurance company why a particular treatment was chosen, creating delays in the billing process.

If recent changes have created delays in getting your payments, you should reevaluate your current medical billing process. If you would like some help to see if our streamlined billing process can help your practice save time and money, please feel free to contact us at any time.

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