Category: Revenue Cycle

Halfway Through 2018 – Where Is Healthcare Headed?

With the first half of the year behind us, we thought we’d share some of the current healthcare trends that are gaining traction in this week’s blog post.  We’ve outlined the top four to keep watch for over the remainder of 2018.

Revenue Cycle Management – Providers recognize the need for more efficient revenue cycle management (RCM) operations to collect payment for services. Implementing RCM technology can help organizations automate this process. In fact, Health Data Management recently named MedeAnalytics to its list of 20 leading revenue cycle management vendors.

In our blog post by Tom Schaal, director of product management, he outlines the need for healthcare organizations to prioritize and develop a RCM strategy that addresses cash collections, bad debt, denials, productivity and what providers should look for in an analytics partner.

Artificial Intelligence – AI is still top of mind and according to research from Accenture, healthcare’s AI market could increase to $6.6 billion by 2021. Many executives think it could take over some clinical tasks, leaving providers with more time to focus on patients. Google is dominating this space in healthcare by debuting its Google Duplex and developing ways for machines to diagnose patients – much like a physician would do.

But staying ahead of the of AI curve can be challenging. Our blog post from Tyler Downs, chief technology officer, offers advice for healthcare organizations to achieve success, like adopting security applications and making sure they have the right team to develop AI.

Prescriptions to Your Door – Amazon has been making headlines in the past few months, from choosing its new CEO for its mega-merger with JP Morgan and Berkshire Hathaway to announcing its plans to purchase PillPack which offers presorted medication and home delivery. Could PillPack soon be a part of the Amazon Prime membership? It’s possible that prescriptions will quickly be delivered in a cost-effective way right to your doorstep.

Doctors Embracing Consumer Membership Fees – Growing patient and physician frustrations around healthcare costs have led to the rise of doctors embracing their own membership fees. In lieu of working with payers under the traditional structure, physicians across the country are opting for a membership model where patients pay these monthly membership fees for their services.

According to a direct primary care physician, there could be as many as 800 direct primary care practices across the U.S., which could increase in the next few years if healthcare costs continue to rise.

Bottom line: the healthcare landscape is always changing, and organizations need to stay on top of trends. MedeAnalytics partners with clients to help them solve these ever-changing challenges. To learn more about how we can help you, contact us here.

5 Ways Analytics in the Business Office Can Improve Your Revenue

Uncompensated care is on the rise. Providers are projected to write off as much as $200 billion by 2019. Value-based reimbursement, ICD-10, bundled payments, and shared accountability payment models are all creating a new healthcare economy.

In this new economy, it’s important to ensure you are paid for the care you deliver. With data analytics in the business office, you can increase collections, reduce denials, and guide business strategy.

Here are the top five ways analytics can help you take control of your revenue.

#1: Prioritize accounts and increase cash

Analytics help you gain big-picture insight into your financial health as well as manage the day-to-day efforts of the business office. You can prioritize accounts and accelerate collections with daily insight into denials, team efficiency, and patient obligation risk. Analytics show the average number of days in accounts receivable (AR), accounts in AR for more than 90 days, coding delays, the root causes of denials, and more—all aimed at increasing collections.

#2: Reduce denials by identifying root causes

Detailed analysis can help you identify exactly why denials are happening and where missteps may be taking place. With insight into denials, you can understand the causes of disputed claims, identify denial trends by payer, and analyze appeal success. Plus, you can identify at-risk dollars and address denials—before they happen—through predictive analytics.

#3: Streamline business office operations

Business office operational tools complement analytics to improve efficiency and productivity. These tools enable your teams to manage and have insight into billing and coding delays, overall time to bill and time to pay, account liquidation timeframes, and avoidable denials caused by missing information or authorization issues.

#4: Improve self-pay collections

Collecting on self-pay accounts can be a challenge for the business office. It’s important to collect, but only in an efficient, cost-effective way. Predictive analytics can minimize time wasted on high-risk accounts, and help you focus on high-value accounts with the greatest likelihood of payment. You can ultimately reduce the cost to collect, streamline financial counseling workflow, and identify patients eligible for Medicaid or charity care.

#5: Analyze the entire revenue lifecycle

With analytics in the business office, mid-cycle, and patient access, you can use your data to improve all points of the revenue cycle. You can identify lost revenue, missed revenue, and revenue at risk—whether it’s due to insufficient documentation, missing charges, denials, bad debt, take-backs, or a lack of insight into the process. You can track all of these “leakage points” in the revenue cycle through a single, integrated data analytics platform.

Learn more about how business office analytics can help you take control of your revenue.

West Tennessee Healthcare: Applying the Power of Data Analytics to Reign in Billing Costs

Between 2008 and 2012, multispecialty practices saw their bad debt go up 14 percent according to a recent survey by the Medical Group Management Association. To curb this debt, many providers are now sending patients who don't pay their bills to collection agencies. While on the surface this seems like an efficient solution, it actually creates more of a billing backlog and negatively impacts the patient experience.

West Tennessee Healthcare is an organization that has taken an alternative route and has seen improvement in collect costs by implementing an in-house process through self-pay. The public, not-for-profit, four-hospital health system based in Jackson, TN implemented Mede’s Revenue Cycle and Self-Pay products to optimize cashflow and improve collections by bringing complex patient accounting data into a unified view. During a recent interview with HealthLeaders, Wade Wright, West Tennessee’s director for hospital billing, said:

“One of the biggest factors in this success is the use of analytics to better understand its patients and to target the right collection strategy to each subgroup…We are using data analytics to prioritize and segment our accounts using different criteria. For example, we can do an analysis of our accounts based on ability to pay or propensity to pay, and we have different methods for reaching out to those segments.”

Through its analysis, West Tennessee now knows that 55% of its self-pay patient population is at a low risk of not paying; 25% is at a medium risk; and 5.6% is at a high risk. Data for the remaining 14.4% is unavailable.

Read more about West Tennessee Healthcare’s success and tips for other providers in the HealthLeaders piece by Rene Letourneau.

Self-Pay: Determining Optimal Care Before the Visit Even Happens

By Tom Schaal, Senior Product Manager, Hospital Revenue Cycle Solution

The Affordable Care Act (ACA) has opened the doors to many new challenges for healthcare organizations, among them is the changed self-pay landscape. While self-pay – defined by both uninsured and self-pay after insurance – has always been a part of the healthcare ecosystem, the shift from uninsured to the high deductibles of many ACA plans has brought self-pay management issues to the surface.

High-deductibles and copayments will leave many patients feeling the burden of out-of-pocket expenses. In just over a decade, the average deductible jumped from $247 to $1,135. Anyone enrolling for bronze level ACA coverage is looking at a $5,081 deductible for individual coverage and the deductible doubles for families. So where does this leave providers? It will ultimately force hospitals to rethink their registration, eligibility, charity screening and collection strategies. Hospitals will need to become proactive when it comes to managing their self-pay risk.

Administrators need to utilize data and predictive analytics to make decisions at the point of registration. Admins can look at a patient’s healthcare credit score and other data points to determine the needs of each patient. Sometimes that information isn’t detailed enough and an organization needs to implement a solution (such as revenue cycle solution) to build a sophisticated patient profile.  

With more intelligent data at their fingertips, providers can make more informed decisions on how to maximize transparency between them and their patients. For example, this data can quickly show a provider that a patient qualifies for charity care and payment assistance programs. Providers can thus avoid inappropriately billing a patient reduce staff time on unnecessary collection efforts and help mitigate bad debt outcomes.

Patients also benefit from intelligent data. For example, a patient access solution allows patients to stay informed about their personal estimated costs before services are rendered, helping them understand the factors contributing to their out-of-pocket liability and avoiding any surprises when they get their bill post-service. This will help patients make informed decisions about their care and increase communication and transparency. More and more technology providers enhance their solutions to include self-pay analytics in a piecemeal effort. If you want to implement a successful program, you should ask yourself the following questions:

Has the technology vendor taken an interest in helping providers manage self-pay before the ACA made it a priority?
Has the technology vendor’s solution evolved over time based on customer feedback and needs?
Do they have a long track record of success working with organizations similar to yours?
Does the solution focus on improving the continuum of care rather than a point solution that doesn’t offer the comprehensive insights you need?

You aren’t alone when navigating this new terrain. Each provider will be seeing an increased emphasis on effective self-pay management and we will work together to optimize the system – leading to greater efficiencies and increased patient satisfaction.