There has been a lot of post-election healthcare speculation on what the future holds for the Affordable Care Act (ACA), and how any changes will impact healthcare organizations. Before the election, President-elect Donald Trump said repeal of the ACA was on his Top 10 list of things that he will work on in his first 100 days in office. There have not been any official plans shared for repeal or replacement since the election, so the healthcare industry continues to wonder and anticipate how it will be impacted.
Regardless of what happens, there is one thing that is consistent in the healthcare industry, and that is inconsistency. We should all be masters at working in a climate of change and being prepared for the unexpected. The best way to be responsive to any future change is to strive to make our organizations as efficient and productive as they can be today.
Changes aren’t limited to whether the ACA will be repealed and/or replaced. There are concerns about how these changes will affect Medicaid expansion programs. Will there be a substantial increase in the number of uninsured patients? And, quite honestly, how will these changes affect an organization’s revenue, bad debt, and collections?
Bottom line…any changes are going to affect the bottom line. Even if the ACA is repealed and replaced with a plan that has no net loss of insured lives, the transition will most likely create processing delays and potential late payments. However, if Medicaid expansion plans are also repealed, or if coverage is limited, there may be an increase in uninsured lives to pre-ACA levels, which will mean an increase in bad debt for hospitals and other healthcare organizations. Either way, there will most likely be an initial negative financial impact to some degree.
How can you mitigate that impact?
Some general questions to ask yourself about your organization:
- Are you efficiently using your available tools and workflows to capture missed revenue opportunities?
- Have you streamlined processes to prevent redundancy of effort?
- Does your organization’s staff understand their role in the revenue cycle process?
- Is your team trained to be consistent and productive, and do they have what they need to do their job?
If the answer is ‘no’ to any of these questions, now is the time to start working on improving your workflows, optimizing your Electronic Health Record (EHR) applications, and improving and/or using reporting tools and dashboards to make sure you are making the most of what you already have available. Take the time to train (or re-train) staff on any areas where there are inconsistencies or new processes.
You can also maximize your opportunity to collect co-pays, deductibles, and self-pays, as well as avoid denials by making sure you use a Real Time Eligibility (RTE) system and/or Insurance Verification system on all patients. Other tips include:
- Perform insurance verification at the time of appointment and/or time of service.
- Set expectations for payment with the patient when they book the appointment or schedule service.
- Collect co-pays and deductibles at the time of service.
- Obtain pre-authorization for services.
- Mail statements throughout the week, and use an online patient portal if available.
- Make it easy for the patient to pay their bills and set up payment plans – online, telephone, credit card, PayPal.
Strong best practices and standards, denial management, and contract negotiation are also critical components in the Revenue Cycle Management arsenal to assist with improving cash collections. Most EHR’s have applications or integrated tools in place to help monitor productivity, create reports, upload new pricing and coding, analyze trends in payer contracts and denials, and automate forms. There are dashboards, drill-down reports, databases, and an abundance of information to slice and dice virtually any way it can be requested. Make sure those applications are optimized to meet your organizations’ needs, and that you can use the data to help your organization be successful.
Every person plays a role in reducing the bottom line for their organization — physicians, clinicians, administrative and billing staff — it all comes down to reducing overhead and increasing collections. How can we bring in the money owed, faster, with less effort? In this industry where there will always be change, that goal is the one consistent thing that we need to be working towards to ensure our financial future.