Becker's Hospital Review

63 Executive Briefing Sponsored by: C hanges in healthcare coverage and reimbursement models have significantly altered hospital revenue cycle management over the last couple decades. Twenty years ago, medical billing processes were almost exclusively focused on achieving optimal private and public payer reimbursement. Today, a significant rise in high- deductible health plans means providers must place greater emphasis on achieving higher rates of patient payments. The shift further complicates RCM models that are already battling significant regulatory, cost-management and policy headwinds. Collections have always been a pain point for providers, and the rise in high-deductible health plans has only amplified the issue. The percentage of Americans under age 65 with a high-deductible health plan increased from 43.7 percent in 2017 to 47 percent in the first three months of 2018, according to the CDC. This proliferation in deductibles, which for many patients now exceed their average annual medical spend, means more healthcare dollars are coming from patients' pockets. Patient out-of-pocket spending grew significantly in 2017, according to JPMorgan Chase Institute. The report found average annual out-of-pocket healthcare spending climbed 8.5 percent in 2017 compared to the year prior, representing the fastest increase since 2014. As patient payments continue to make up a larger share of provider revenue, financial leaders need to deploy new strategies to increase collections and help patients navigate their rising medical costs. Exceeding patients' expectations when it comes to financial experience is in the best interest for providers. Step one is sunsetting outdated, inefficient RCM systems. RCM's bolt-on problem The emergence of the patient payer spurred the creation of bolt-on technologies to make RCM services more effective. Add-ons like service portals and payment dashboards have helped providers get a better sense of patient populations and their propensity to pay. These technologies examine physician and patient data to craft the best avenue for physicians to reach their patients, so they can receive reimbursement for their medical services. The issue with these bolt-on technologies is that the information they gather is not integrated. Instead, disparate data generated by each add-on technology is handed to the RCM department in buckets. The department is then responsible for synergizing non-standardized data into a timely and correct insurance claim, a burdensome and costly task for an already overworked department. When it comes time for provider organizations to follow up with the patient about any remaining balances not covered by insurance, mismatched and incorrect financial data could have slipped past the bolt-on solutions from different vendors. Such inconsistencies result in billing errors that confuse patients and negatively affect their opinion about a provider — even if clinical care was excellent and outcomes were positive. A recent report from InstaMed found 65 percent of patients would consider switching providers if it meant having a better experience with payments. As provider revenue attributed to patient balances grew 88 percent from 2012-17, providers can't afford this type of churn. "At the end of the day, we don't want the financial experience to have any bearing on the clinical experience," David J. Law, chief client officer for revenue cycle and practice management company Zotec Partners, said. "If the patient has a bad financial experience, they are much more likely to not refer or go back to that provider. It has nothing to do with the quality of the care. It's all about the financial experience." The new patient payer paradigm is altering the C-suite's approach to RCM. Leaders now see new methods and solutions to improve patient payment as crucial to achieving patient-centered, value-based care. To avoid balance errors or incorrect claims, providers need to have an integrated billing solution that removes the need for multiple third parties. Such a solution brings all the processes — including eligibility checks, claims processing and patient balance estimates — under one platform. Patient payers are bucking the RCM status-quo — Why now is the time for providers to pivot from bolt-on to fully integrated technology

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