Becker's Hospital Review

12 Executive Briefing Sponsored by: lot has changed in healthcare over the past two decades. Medical records are stored in computers, patients can video chat with providers from home, and it only takes a few seconds for physicians to send test results from the hospital to their office. Beyond technological advancements, social movements and significant regulatory changes have fueled major shifts in the practice of medicine and the business of healthcare over the past 20 years. A profusion of new reimbursement and care models have guided hospitals, health systems and other providers toward reducing healthcare costs and improving quality of care. More recently, healthcare organizations started reaching beyond cost and quality to incorporate more patient engagement into their strategic goals. Addressing all three dimensions simultaneously is challenging and requires constant communication and coordination across multiple departments. Initial conversations about improving the patient experience were primarily focused on clinical care, but more and more hospitals are expanding the discussion to include financial services. Hospital and health system reimbursement is more closely tied to patient satisfaction than ever before, which makes it vital for providers to examine how their billing and payment processes affect the overall patient experience, according to T. Scott Law, founder and CEO of Zotec Partners, a leading healthcare revenue cycle management services provider. Mr. Law founded Zotec Partners in 1998 as a specialized revenue cycle provider for radiology practices. Over the past two decades, the company has expanded its services to hospitals and health systems across the nation and evolved to help these organizations smoothly adjust to changes in the industry. Zotec Partners is currently assisting medical providers with an issue that is top of mind for many healthcare executives: the increasing connectedness between the patient experience and the financial well-being of hospitals and health systems. Patients as payer Traditionally, provider organizations centered their revenue cycle management strategies on commercial and government payers, but that has changed with the rise of high-deductible health plans. Patients are now in charge of more healthcare dollars than ever before, and they are one of the fastest growing payers. In fact, a 2017 report from Black Book revealed patient healthcare costs — including deductibles and out-of-pocket maximum payments — have soared nearly 30 percent since 2015. Revenue cycle performance in healthcare is challenging due to many factors, including the complex nature of services billed, and different reimbursement rates and contracts for each insurance company and government program. The process has become more complicated as patients have evolved into primary payers. This trend requires hospitals, which have historically received only a small fraction of what they are owed from patients, to engage with patients in new ways and to update their billing and collections practices, according to Mr. Law. "The biggest evolution of Zotec is we used to be a business- to-business transaction set. Now, it's business-to-business-to- consumer," he said. "We've added a third level of collection techniques." The business-to-business model was pretty straightforward: a provider organization would electronically submit a claim to an insurance company, and the insurer would adjudicate the claim and pay the provider for services rendered. That transaction model has since evolved in complexity. Under the new model, provider organizations still submit an electronic claim to an insurance company, expecting to get reimbursed based on contracted rates. However, the insurer may come back and say coverage has not kicked in because the patient has not reached his or her annual deductible. In these cases, which are becoming more common, the hospital or health system is tasked with trying to collect from the patient. More patient financial responsibility shouldn't mean more bad debt A

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