Clearwater, Fla. (PRWEB) February 13, 2013
Health reform will create a significant impact on revenue cycle management in 2013 – and hospitals and other providers must be prepared to respond, advises Pyramid Healthcare Solutions, a leading provider of revenue cycle services.
“There is concern among healthcare executives on what impact health reform will have on their operations and cash flow as major changes go into effect over the next few years,” says Jay Hutchinson, Chief Operating Officer at Pyramid Healthcare Solutions. “We are seeing an accelerated movement by the industry to get a handle on costs and explore outsourcing.”
Hutchinson cites these top five revenue cycle issues facing healthcare executives:
1. Reimbursement and Cash Flow Pressures. Reimbursements will continue to erode with expected Medicare reductions as well as Medicaid expansion in 2014. Health reform also will create a rise in high deductible plans passing more costs onto the patient. Providers will see a significant increase in self-pay accounts making collections a challenge. The Healthcare Financial Management Association’s (HFMA) recent survey of 300 hospitals indicated declines in patient revenue and cash on hand. Healthcare organizations must implement strategies to increase cash, such as business office process improvement, front-end collections, reduction in aged A/R, denials management and outsourcing to improve self-pay collections.
“This is the year that providers have to get their shops in order because come 2014 it will be too late as 30 million newly covered people hit the industry,” says Hutchinson.
2. Business Office Consolidations. Reform is driving healthcare organizations to consolidate operations and/or merge with other providers to capture market share and improve patient outcomes. As reimbursement gets tied to the quality of care, hospitals must control all facets of the care continuum from pre-acute to post-acute care. Hospital and physician merger activity will require the consolidation of existing business office operations, creating a need to reevaluate revenue cycle infrastructures.
3. New Payment Models. The Centers for Medicare & Medicaid Services (CMS) just announced 106 new Accountable Care Organization (ACO) programs, nearly doubling the national total. ACO is a pay-for-performance model that rewards based on outcome rather than fee for service. Many hospitals are experimenting with variations of this method. Numerous existing patient accounting systems are not currently built to process bundled payments, and most revenue cycle personnel are not trained for this method.
Hospitals and other healthcare organizations will need to determine what conditions and procedures constitute a “bundle” and how to disburse payments based on performance metrics, explained Hutchinson. Business intelligence will be a hot topic in 2013 as healthcare organizations need data to understand the cost and impact of various disease states on their operations.
4. Medical Coding. “Although much discussed in recent months, it can’t be ignored and bears repeating when listing top trends – the transition to ICD-10 medical coding is a critical development,” says Hutchinson. The new medical coding system will affect more than just reimbursement rates, but impact electronic health records systems and other key data and analytics technologies, too.
“Hospitals must dedicate resources, manpower and time toward mastering the new ICD-10 coding system. And, with the government mandate to cut costs, attention must be given to all medical coding practices, which can yield desired results through reduced errors and other improvements,” Hutchinson adds.
5. Outsourcing. The demands outlined here and others will drive an increased number of providers to work with healthcare financial consultants, according to industry experts. One report reveals that the top 20 healthcare consulting companies grew their businesses by 13 percent between 2010 and 2011. Providers will be resource constrained as they struggle to find experienced coders and revenue cycle personnel to handle the new mandates and increased volumes. The cost to collect from a patient versus a payer is significantly higher leading providers to seek out outsourcing as a cost saving strategy.
“Revenue cycle outsourcing will be a key strategy for healthcare organizations as they prepare for the major changes coming in 2014,” says Hutchinson.
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About Pyramid Healthcare Solutions
Founded in 1985, Pyramid Healthcare Solutions partners with healthcare providers to assess, validate and resolve gaps in their revenue cycle, leading to improved and sustainable financial results. Pyramid offers a complete best-practice suite of revenue cycle solutions, including coding services (on-site and remote), HIM services, cancer registry, revenue cycle, revenue discovery, charge capture, accounts receivable management, patient financial services, human resources, managed care services, and education and training. Headquartered in Clearwater, Fla., Pyramid employs more than 300 credentialed, knowledgeable healthcare professionals and best practices developed with more than 500 clients. For more information on Pyramid Healthcare Solutions, visit http://www.pyramidhs.com.