Does your revenue cycle need an update?

As the healthcare eco-system changes, erstwhile realities that the billing solution providers were used to are undergoing a change. They need to gear up for these changes to ensure that they stay afloat when the rules of the game change and the dust has settled.

• Increased Risk Exposure

  Popularity of high-deductible plans creates a rather precarious situation for providers and billers alike. The RCM cycles of most billing organizations were put in place assuming the payers to be the ‘primary’ if not the only source of payments. This assumption is being violated now and not many billing departments are geared up for this change from what was a B2B context to a B2C context.

• Medicaid Managed Care

  Managed Care being an efficient system to manage cost, utilization & quality, lets its members to flexibly enroll & un-enroll between different plans throughout the year. This could be because the patient’s Primary Care Physician not being part of MCO network, patient needed services not being covered by MCO Plan etc., which may result in No coverage denials when claims are not submitted in time.

• Value Based Care

  As transition to value based care happens, the way billing departments were used to billing will change. The departure from Fee-For-Service (FFS) will demand an understanding of ‘whether’ a particular service ‘can’ be billed or not. While providers will be answerable, the systems that billers have in place need to be equipped to accommodate this change.

• Evolving Payer Environments

  Payer systems have been in flux as the information they expect and the way they expect that information keeps changing. Annually changing CPT does (Yes it’s going to happen in 2017 again), Revenue codes etc. demand the biller systems to be flexible and adaptive to reflect the change without stretching the AR cycles for the providers.