Reimbursement is a tricky subject for many organizations to tackle and healthcare is no exception. The healthcare reimbursement environment is complex with multiple sets of payers and multiple sets of rules that are often changing. How can organizations involved in this field best work through the clogs in the system that prevent forward movement?
While providers have to be nibble and prepared to adjust to the changes in regulation and the impact of healthcare reform, CFOs are working quickly to understand the new payment models and the changes that surround the rollout of health insurance exchanges. With much of healthcare organizations revenue coming from the fee-for-service system, how can physicians and hospitals put themselves in a place where they can succeed in a reimbursement environment?
Healthcare executives need to take a step back and look at what the factors are that are impacting the professional revenue cycle and ways that they can implement organizational models that create efficiencies in billing operations and claim management.
Health care consultants believe that if the professional revenue cycle is not managed effectively, billing costs will rise, collection rates will drop, and accounts receivable (A/R) will increase to the point that the value of the acquisition is lost.”
As the structure of providers is changing and hospitals are acquiring or developing affiliations with smaller, independent practices, it is especially important that organizations understand the full healthcare revenue and reimbursement cycle.
There many billing models for this vertical, each with their own set of advantages and disadvantages:
The healthcare organizations that are most successful in managing their revenue cycle are those that have access to the overall picture and ensure that their system consists of the following parts
“Actively reviewing the revenue cycle of your clinical practice will identify opportunities for cash improvement, cost reduction, and increased margins, regardless of whether billing functions are centrally maintained,” says Colton.