“Would you consider bringing your car in for an extensive repair job that takes highly skilled mechanics several hours, and then drive your car away without paying?”
Of course not. None of us would. We have heard this and similar analogies from our clients and colleagues when lamenting all the revenue hits the practices are taking due to patient payment-related bad debt. The healthcare industry spends more than $400 billion annually on payments, billing, claims processing, revenue cycle management, bad debt, and collections. As patients’ out-of-pocket expenses continue to balloon, and high-deductible health plans (HDHP) become increasingly common, healthcare organizations must find a method of collecting more from patients.
For our clients who are staring down huge amounts of bad debt related to services their patients haven’t paid for, the trend toward much higher patient payment responsibility can mean a hot-and-cold relationship with patients.
It’s possible this stems from a disconnect on both sides of the equation: Many patients don’t understand that they are now responsible for paying for more of their healthcare services, and some practices have not yet optimized their processes to make patient payment easy and efficient.
The world has shifted for many of our clients and healthcare organizations of all type and sizes. According to the Medical Group Management Association’s (MGMA) research in 2010, $1 in every $4 of payments comes from patients, and that trend has only continued and intensified since then.
The patient wields unprecedented power and responsibility in the new healthcare terrain, and many healthcare organizations aren’t doing enough to facilitate better patient relationships and smoother patient payments, which is directly impacting revenue.
Two common questions we field from clients are: “So how do we know when we’re done optimizing? When do we know our revenue cycle is good to go?” These are the billion-dollar questions. Similar to a patient with an ongoing condition asking, “When will I be cured?” the answer is always going to be, “Well, […]
Just recently, a longtime partner of ours, a diagnostic services center based in the West, reported to us some truly amazing revenue numbers from last year’s third quarter. PRN is so proud to have been a part of their story from the time they were just one small location barely beginning to tweak their revenue […]
Jamie Hernandez, a 41-year-old former Division III soccer player, walks into a physician-owned outpatient surgical center for a knee arthroscopy. Due to an innocent keystroke error, a staff member sends the invoice for Jamie’s procedure to Jaime Hernandez, a 72-year-old retiree who had a total knee replacement at the center a couple of years ago. […]
Imagine this nightmare scenario: You’ve decided to take a good look at how duplicate patient records might be wreaking havoc in your master patient index (MPI) and handicapping your revenue cycle. You’re relatively certain that a few clerical errors—like transposed dates or letters—led to a small number of duplicate records. That sort of thing happens, […]
Working with so many healthcare organizations on facets of revenue cycle management like billing and practice management over the years, we know industry trends can have huge impacts on our clients. From regulatory changes to new technology advancements, changes in the industry affect how our clients do business.
Acquiring or launching a specialty pharmacy practice is one trend we’ve been keeping our eyes on recently. It has grown in popularity due to soaring drug prices. Has your practice thought about how acquiring or building a pharmacy practice might impact your revenue cycle in the short and long term?
Benefits of Acquiring or Launching a Specialty Pharmacy
The trend of pharmacy growth didn’t come about in a vacuum — like most healthcare trends, it grew to fill a gap.
In 2014, the United States spent $124.1 billion on specialty drugs, up from $98.1 billion in 2013. Despite an average growth for pharmaceuticals of 20 percent a year, hospitals fill their own prescriptions less than 20 percent of the time, and clinics and outpatient services are often comparable. This highlights a sizeable gap where practices who might need specialty drugs for patients or procedures are putting a significant portion of their revenue at the mercy of a third party that is not bound by payer contracts or rates.
Over the past several months, we’ve come to some realizations we hadn’t previously about the recent big change to ICD-10: Many healthcare organizations who used the grace period leading up to ICD-10’s official arrival to prepare were blindsided by the little ways ICD-10 immediately impacted what they thought were small areas of their revenue cycle.
By any measurement, and in any context, going from 13,000 of something to 68,000 of something is a big jump. When we’re talking about codes used to drive the payments and reimbursements of one of our country’s most crucial and complex industries — healthcare — it’s easy to see why the ICD-10 transition is considered one of the most important changes in the field in a generation. For the most part, it looks like the big-picture transition has gone very smoothly for almost all healthcare entities and payers — everyone is mostly using the right codes and not seeing a drastic rise in rejected claims or other issues.