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How smart claims processing will transform claims handling

doug@promedllc.com (PROMEDICAL ) — Wed, 22 Jul 2020 04:00:00 GMT

Using smart revenue management systems leads organizations to more efficient processing.

In 2016, healthcare vendors need the most efficient claims processing systems out there. By now, flexible, web-focused methods for important claims tasks are clearly the industry's path forward, and will play a major role in bridging the gap between patients and providers. A fast, digital claims method makes a direct link from implementation to delivery for workers' compensation and motor vehicle billing alike.

Now is the time to invest in better revenue cycle management, with a focus on detail-driven, well-facilitated collection that breaks down barriers. Despite the growing pains involved with adopting any new technology, there are a couple of areas where smarter systems have already improved claims processing online.

Direct accessibility

With each new convenience, the future of healthcare looks more integrated. Data analytics harvests insights from seemingly unrelated details for fuller results. To make this innovation worthwhile, however, there needs to be a distinct pipeline between entities.

"Data analytics harvests insight from seemingly unrelated details."

Online healthcare portals are already addressing this need, providing direct communication through smart devices like phones and tablets. By bringing necessary information together in a simple, accessible source, these solutions set the stage for clean claims assembly.

Shorter cycles

Proper collection from the outset can reduce the amount of work hospitals have to do later if the claim is resubmitted, according to Gary Marlow, Vice President of Finance at Beverly Hospital and Addison Gilbert Hospital.

"From a revenue cycle perspective, getting the most accurate information up front starts with patient scheduling and patient registration," Marlow told RevCycleIntelligence in 2015. "That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible."

The way information enters the claims process can impact how it gets managed. If technology, like artificial intelligence, is present at the beginning and guides the claims throughout, there's a consistent system handling the information the process to meet best practices.

PROMEDICAL's benefits

With our secure, efficient and comprehensive system, PROMEDICAL is staying ahead of the game. We're doing that by developing the following features:

Communication: Users can choose from multiple languages with our online offerings. This allows you to customize your system to better reach patient populations and keep claims moving faster.
Customization: If our proprietary options aren't currently meeting your needs, we can change them to do so based on feedback. Adapt to state fee schedules or language demands on a case by case basis.
Encryption: A must for secure file exchange, PROMEDICAL ensures a secure file transfer process. Our process protects backup data equally strong as primary data, for efficient security across the board.
Planning: Organizations also benefit when a set deadline is involved, putting clear limits on when submissions are set for review. Processing records requests within a preordained period of days helps managers know what to expect, and regular reports set up clear overviews of important statistics.

Contact PROMEDICAL today to learn more about our healthcare revenue cycle solutions.

How does ridesharing impact hospital reimbursement?

doug@promedllc.com (PROMEDICAL ) — Mon, 02 Mar 2020 15:53:59 GMT

Ridesharing introduces further complexity to hospital revenue cycle management processes. Who receives the bill when a rideshare driver or passenger is injured?

According to Pew Research, 15 percent of U.S. adults have used ridesharing services . Where does insurance enter the picture? Uber, Lyft and other ridesharing apps throw a proverbial wrench in hospitals' revenue cycle management operations. Billing is already a major pain point in hospitals – Black Book Research noted most facilities are outsourcing their RCM because in-house teams lack the resources to efficiently handle motor vehicle reimbursement. Ridesharing will only exacerbate the issue.

For example, if a rider gets injured and has to go to the hospital, from which institution does the hospital receive reimbursement : The driver's insurance? The passenger's? Uber's? As Uber and Lyft are the most popular ridesharing apps, we'll focus on how these companies handle driver insurance.

How do Lyft and Uber insure drivers?

Lyft has three types of coverage within its insurance policies:

Contingent Liability activates when a driver logs into the app and requests to accept rides – a state Lyft designates as "Driver mode." This coverage provides up to $100,000 per accident for bodily injury.
Contingent Comprehensive and Collision kicks in when a driver has picked up a passenger. This coverage applies when a non-collision event damages the driver's vehicle.
Uninsured/Underinsured Motorist applies when an at-fault driver who is uninsured or underinsured causes bodily injury to himself, his passengers or any third parties. The coverage provides $1 million per incident, and includes no deductible.

For example, if a driver is injured in an accident at a time when he is not working for Lyft, his personal insurance will cover him (assuming he lives in a no-fault state, but that's another issue). However, when the driver activates Driver mode, Lyft's Contingent Liability will protect him even if he hasn't accepted a ride from a passenger.

What if the driver's at fault? According to Rideshare Dashboard, Lyft's commercial insurance will cover all damages to third parties and the passenger, but the driver will have to cover his own medical expenses. That's when state laws dictate payment. In Massachusetts, for example, which also happens to be a no-fault state and requires all motor vehicle owners to possess auto insurance, the rider's personal auto insurance will cover the medical bills.

Uber's insurance system is somewhat similar to Lyft's but possesses a few minor differences. For example, when an Uber driver is transporting a passenger, and another motorist causes an accident that results in bodily injury to the driver, the passenger and anyone else involved, Uber's UM/UMI will cover bodily injury of anyone in the rideshare vehicle.

Uber and Lyft provide UM/UMI insurance for all of their drivers.

Who pays in what situations?

Accidents are complicated matters, and state laws regarding fault are difficult to navigate. In cases where the rideshare driver is not at fault and is transporting a passenger, the ridesharing app's coverage will receive the bill for treatment. However, in circumstances where the driver is at fault, the institution which pays passenger and driver medical bills depends on the state in which the accident occurs.

With respect to how ridesharing impacts hospital RCM, we've only scratched the surface. For example, what if a rider is injured in a fault state, and the Uber driver is at fault? How would the billing department obtain settlement? We'll continue to dissect ridesharing's impact in future articles, so stay tuned!

How technology fits into RCM

doug@promedllc.com (PROMEDICAL ) — Tue, 28 Jan 2020 05:00:00 GMT

Let’s take a closer look at the benefits of utilizing technology, plus some of the emerging resources your facility can use to revamp your current RCM processes.

With new, transformative technological advancements on the rise, it's no surprise that nearly every industry is feeling the impact of the digital age. From a healthcare provider's perspective, new resources can be used to revamp the current revenue cycle management processes you have in place. To reap the benefits of an optimized approach, you must be willing to take advantage of such emerging technological tools and resources, as stated by Chad Sandefur, Director and Healthcare Analyst at AArete.

"Generally speaking, in order to strengthen the revenue cycle management, embracing technology within the revenue cycle is key," Sandefur shared with RevCycleIntelligence.com. "Having the platforms to seamlessly facilitate provider-payer interactions are really integral. In many cases, it's mostly about bad debt avoidance. With that in mind, there are a few specific points."

Let's take a closer look at the benefits of utilizing technology, plus some of the emerging resources your facility can use to revamp your current RCM processes:

The benefits of an optimized approach

By paying attention to the new digital advancements that can benefit your RCM, you can ultimately impact the workflow of your staff members while better streamlining services for consumers. Here are some of the advantages of an optimized approach:

Reduced chance for human error – Human error is inevitable when handling large amounts of data. Management software can be used to keep track of patient data input and maintenance.
Better opportunity for precise, automated data entry – Between appointment scheduling, data input and claims submission, employees have a lot of duties. Automated software can take care of some of these responsibilities, allowing staff members to better focus on a single task at a time.
I ncreased cash flow – Claims management technology can expedite claims quickly and produce clean, accurate claims, ultimately increasing cash flow , as stated by Becker's Hospital Review.

Optimizing your RCM approach can lead directly to a significant return on investment and improve the overall reputation of your billing department.

Invest in technology that can enhance your revenue cycle management system.

How technological resources can impact your RCM

With the right tools and resources in place, you can elevate your revenue cycle management processes to another level. Here are some of the ways you can utilize technology to create clean claims and produce faster solutions in your health system:

Introduce alternative forms of payment: Technology provides new ways to offer patients different methods of payment, which can ultimately reduce denials and create clean claims. Modern Medicine Network recommended utilizing technology that lets patients pay via electronic bank payment, health savings account, credit card, cash or check, as well as in person, online or over the phone. Introducing multiple forms of payment can encourage patients to pay balances on time.
Consolidate your systems: An advanced digital platform allows the hospital financial department to track patient care, registration, appointment scheduling, payment balance and more by consolidating all tasks into one system.
Reach out to patients in advance: By utilizing a digital communications system, you can reach out to patients in advance and collect important information in a timely manner. With permission to send appointment reminder text notifications and patient questionnaires via email, you can collect the most accurate data and reduce denials later on.
Eliminate manual data entry: Automation software ensures that the correct data is loaded into the system, reducing errors and speeding up the approval process.

Financial departments must take advantage of healthcare apps, analytics reporting tools, automation services and other emerging technology to stay at the forefront of the industry. This will improve revenue cycle management processes and produce a positive outcome for the hospital's bottom line.

The role of manufacturers in texting and driving accidents

doug@promedllc.com (PROMEDICAL ) — Sun, 29 Dec 2019 05:00:00 GMT

Are iPhone manufacturers like Apple responsible if drivers use their phones and end up crashing?

The danger of texting while driving is complicated by the increasing functionality of smartphones. When drivers depend upon their handheld phones for navigation and other features, they could raise the risk of distraction and possibly cause an accident while in transit. However, a new case brings an interesting wrinkle to this situation by asking: Could the phone manufacturer be liable?

Last month, The New York Times looked at whether or not Apple could implement a "lockout" feature to prevent drivers from using certain aspects of their iPhones while behind the wheel. According to the source, Apple received a grant for this technology in 2014, though it is unclear whether or not the program is actually in development.

Nonetheless, it shows that the company has at least been aware of possible steps it could take to address a cause of accidents. The discovery comes in the context of a 2013 car accident case involving a driver using a phone.

"The New York Times looked at whether or not Apple could implement a 'lockout' feature."

However, even though the court has brought up interesting questions, Axinn Veltrop & Harkrider LLP's technology litigation expert Gail Gottehrer argued that blaming the phone during an accident doesn't make logical sense.

"If you think about it, then you would have manufacturers being responsible for all sorts of distractions," Gottehrer said. "For example, all too often you drive past somebody who's reading a book on the steering wheel. Does that mean that distraction is the source of an accident if it happens, so you would go back and sue the book publisher?"

PROMEDICAL is a national healthcare revenue cycle management company. Since 1995, we have provided the healthcare community with a client- focused, technology driven, revenue cycle partner. Our third-party liability solutions include workers' compensation and car accident injury claim billing. A partnership with PROMEDICAL ensures proper reimbursement, timely resolutions and increased cash.

3 Ways to Reduce Hospital Revenue Cycle Management Costs

doug@promedllc.com (PROMEDICAL ) — Fri, 20 Dec 2019 05:00:00 GMT

Decreasing overhead enables care providers to dedicate limited financial resources to where they are most useful: procuring new equipment, hiring personnel, training existing staff and other investments. Allaying financial scarcity entails identifying the largest costs and implementing processes to reduce them.

The hospital revenue cycle is a major source of fiduciary waste in health care institutions. A study from McKinsey & Company found that revenue cycle inefficiencies cost 15 cents on every dollar health care institutions obtain. In a $2.7 trillion industry, $400 billion goes to claims processing, billing and revenue cycle management. How can providers reduce this financial burden while maintaining compliance and without compromising the patient experience? Here are three powerful strategies to consider.

1. Outsource workers' comp and MVA Complex Claims

Given the financial and regulatory pressures under which hospitals operate, they rarely possess the administrative resources to optimize the revenue cycle, especially with respect to receiving payment from automotive insurers and workers' compensation programs.

Consider the following situation: A New Hampshire hospital treats a patient from Massachusetts who was in a serious car accident. Delivering the care costs $12,000. In this case, the hospital will have to coordinate benefits between the patient's automotive insurer and his health insurer to determine proper reimbursement allowed on the claim, according to Massachusetts State Law.

The patient finance department may not have the technology or expertise needed to efficiently orchestrate payment from both parties. Collecting payments from a Massachusetts-based auto insurer may not warrant the same system as obtaining settlement from an auto insurer in New Hampshire, given that the latter state possesses at-fault laws. In addition, if the hospital discovers minor injuries that require treatment, but may or may not be related to the accident, the auto insurer may push back over which charges it should cover.

To reduce health care RCM costs, hospitals should consider outsourcing their workers' comp and automotive insurance payments management to parties that provide health billing services, manage attorney correspondence, negotiate claims and conduct other administrative responsibilities. According to Black BookMarket Research, 54 percent of health care financial executives believe outsourcing RCM enables them to increase efficiency and improve fiduciary well-being.

2. Find a RCM partner that optimizes IT consumption

IT can either be burdensome or advantageous, depending on the manner in which administrators utilize existing systems. When outsourcing their RCM, hospitals must assess their partners' technical wherewithal and resources, asking the following questions:

Is partner's application proprietary? If so, does it have a robust, responsive and dedicated development team?
How does the application support claims management?
Is the application compatible with in-house resources? Does it require any special integration?
What differentiates the partner's application from third-party solutions?

The latter question warrants further expansion. The value an RCM partner's technology brings to the table depends on how well the partner integrates its knowledge expertise into the application's function. For example, the solution must bring clarity to complex claims processes involving interstate communications while acknowledging the state laws and guidelines.

3. Keep patients informed on medical billing

Hospitals must also educate patients as to who will pay their bills under specific circumstances. Chad Sandefur, director and healthcare analyst at AArete, explained that ensuring patients develop this knowledge is critical to avoiding bad debt, RevCycleIntelligence reported.

"By training staff to collaborate with patients and to educate them early, it removes the surprises when the bills come and that facilitates the payment component," Sandefur told the publication.

Providing such knowledge does involve detailed instruction, however. RCM partners can assist administration in educating nurses, physicians and other staff to mitigate the burden of transferring information to professionals interacting with patients.

How can hospitals use analytics?

doug@promedllc.com (PROMEDICAL ) — Sat, 30 Nov 2019 05:00:00 GMT

But how exactly can the healthcare community benefit from this? Here are a few ways hospitals can use analytics and drive insights.

The ability to assess analytics through predictive modeling is quickly becoming a key technology throughout the healthcare sector. In fact, a survey by Health Catalyst found that 80 percent of hospital leaders believe that predictive analytics can improve the future of healthcare.

But how exactly can the healthcare community benefit from these tools? Here are a few ways hospitals can use analytics and the insights they produce:

Assess data for clinical decision support

The health of the patient should always be the top priority of the healthcare provider. By utilizing analytics for clinical decision support, medical experts can make more informed decisions, which can ultimately lead to cut costs as well as better outcomes, according to George Zachariah, a consultant at Dynamics Research Corporation in Massachusetts.

"Medical experts can make better decisions about their patients by utilizing analytics."

"If all the important information is on one electronic dashboard, clinicians can easily see what needs to get done for a patient, and what has already been done," Zachariah told Healthcare IT News. "They can then make clinical decisions right on the spot. In addition, clinicians will not be double-prescribing patients certain medications due to the lack of information they have on the patient."

Analyze denials for future prevention

Because the revenue cycle contains many touch points, there's plenty of room for claims to unravel and produce other errors, according to Healthcare Finance. To reduce denial prevention for the future, hospitals can encourage the revenue cycle management department to take an analytics-driven approach. Identify where your inefficiencies most often occur – perhaps through registration data entry, eligibility and benefits checking, coding, clinical documentation or elsewhere. Assessing denials by identifying processes and errors can put things into perspective and prevent a given problem from occurring again in the future.

"While about two-thirds of denials are recoverable, almost all are preventable," Marcy Tatsch, senior vice president and general manager of reimbursement optimization solutions of a tech company told Becker's Hospital Review. "So identifying and resolving the root causes of denials has a larger financial benefit than appealing and overturning them. Managing denials begins with using available data to analyze where errors and slowdowns occur, prioritizing those causes, and then addressing them."

Evaluate analytics to prevent fraud and abuse

Zachariah also mentioned that a significant amount of money is spent on cleaning up the mess that is fraud and abuse in the healthcare community. Hospitals and facilities can use analytics to provide insight into patient information for determining whether such abuse is occurring.

"Analytics can track fraudulent and incorrect payments, as well as the history of an individual patient," he said. "However, it's not just about the analytic tool itself but understanding the tool and how to use it to get the right answers."

While health systems need to prioritize patient health, they also need to maintain financial viability. Preventing and managing claim denials, removing obstacles to payment and reducing debt in correlation with fraud and abuse is key. By utilizing advances in analytics technology, the healthcare community can assess data and learn from insights that would otherwise remain hidden, and which can lead to performance improvements across the board. Having a secure, analytics-driven management system in place can lead hospitals to success and foster consumer and patient satisfaction.

How hospitals can reduce compliance and revenue cycle management costs

doug@promedllc.com (PROMEDICAL ) — Mon, 11 Nov 2019 14:38:46 GMT

A significant percent of hospital administrative costs come from billing and insurance-related activities. How can institutions address those expenses?

Looking ahead into 2020, it appears delivering health care will require more resources than last year. A report from PricewaterhouseCoopers found medical costs will increase 6.5 percent this year. Hospital inpatient and outpatient spending make up the bulk of these costs – 30 percent and 19 percent, respectively.

Why is the cost of care rising? Administrative resources are stretched thin. PwC noted care utilization is rising among patients, but hospitals are struggling to find the human capital required to manage an increasing number of payments while complying with state regulations. How can administrators reduce hospital revenue cycle costs without violating compliance standards?

"In 2012, business and insurance-related spending accounted for 15% of health care spending."

The costs of revenue cycle management and compliance

Let's start with a fiscal overview. A study conducted by Aliya Jiwani, a researcher at the University of California San Francisco's Philip R. Lee Institute for Health Policy Studies, determined the percentage of billing and insurance-related (BIR) activities as a part of overall care costs in hospitals, physicians practices and insurance companies.

Jiwani and her colleagues discovered BIR expenses totaled approximately $471 billion in 2012. Overall, BIR accounted for 15 percent of health care spending. Recent research suggests this percentage may be even greater today. Given the complexity associated with hospital billing, it's not surprising BIR expenses are so high. What's happening in the background?

What's behind RCM costs?

There are several reasons as to why revenue cycle management (RCM) consumes so many resources, especially with respect to billing auto carriers, worker's compensation firms and other payers specializing in accident claims. Motor vehicle accident (MVA) claims, for example, are regulated by every state's property and casualty laws, which determine who is responsible for providing payment in certain situations. These laws leave administrators with the task of:

Figuring out how to bill for a service.
Determining how long the accounts receivable should be on the books.
Authenticating the patient's place of residence and other demographic information that may affect the claims process.

Further complications arise when a patient residing in a no-fault state, such as Florida, is injured while driving in a fault state such as Georgia and visits a hospital in Atlanta to receive treatment. According to the Insurance Information Institute, as per Florida law, the insurance company has to cover the patient's financial losses associated with the accident, but does that stipulation apply when the patient in question is injured in Georgia? This doesn't even touch on which party the Atlanta hospital should bill for services.

The advantages of outsourcing RCM

It's more financially viable for administrators to outsource their MVA revenue management responsibilities to businesses that possess the knowledge and resources required to process payments efficiently. When selecting an RCM partner, hospital administrators must ensure a prospect has the following capabilities:

A fully-staffed legal team that can address litigious issues.
A rules engine that spots underpayments when they occur.
Revenue cycle service staff specializing in MVA, worker's compensation and other niche insurance facets.
A database of all statewide laws regarding MVA.

Overall, partnering with an RCM specialist enables administrative staff to focus on processes with which they're more familiar. In addition, hospitals can reduce the costs associated with managing MVA claims while ensuring they're complying with statewide regulations. If care costs continue to increase in the near future, it's likely outsourcing will become a more popular strategy among administrators.

CMS issues new guidance for following HIPAA into the cloud

doug@promedllc.com (PROMEDICAL ) — Thu, 24 Oct 2019 04:00:00 GMT

The Department of Health and Human Services has released multiple guidance relating to best HIPAA practices.

HIPAA compliance is important both for hospitals and every organization they work with that handles personal data, including medical billing firms. The Department of Health and Human Services has published new guidance, however, addressing the rigors of HIPAA rules with the growth of cloud computing. With cloud technology posing possible advantages for healthcare, the advisory may be especially important.

As the official HHS site said, the guidance applies specifically to "business associates," among others, to address possible questions surrounding cloud use. While a covered entity can store electronic protected health information in the cloud, it has to sign a "business associate contract or agreement" to assure HIPAA compliance.

"The new guidance may prove especially important with cloud technology."

Since HIPAA is multilayered, entities will have to remember the applications for the Breach Notification, Privacy and Security Rules. The source also noted that Cloud Services Providers are still business associates even if all of the protected data they store is encrypted.

Though the guidance also avoids recommending any particular brands, it does allow providers to access relevant information in the cloud through mobile devices if they take the correct precautions.

This follows other HIPAA guidance released earlier this year. In a press release from Feb. 25, Jocelyn Samuels, director of the HHS Office of Civil Rights, said that individuals are "empowered" when they have the right to send information to a third party. This may have been about a separate HIPAA issue (right of access), but it sill ties into the ways the HHS is preparing for greater concerns.

PROMEDICAL is a national healthcare revenue cycle management company. Since 1995, we have provided the healthcare community with a client- focused, technology driven, revenue cycle partner. Our third party liability solutions include workers' compensation and motor vehicle accident billing. A partnership with PROMEDICAL ensures proper reimbursement, timely resolutions and increased cash.

RCM continues to trend toward automation

doug@promedllc.com (PROMEDICAL ) — Thu, 03 Oct 2019 04:00:00 GMT

Despite obstacles such as cost and security, RCM departments continue to push toward automated solutions to improve the patient experience and maximize reimbursements.

We live in an increasingly automated society. From ordering coffee on an your phone to asking Alexa to write down your to-do list, you can now complete processes faster and more efficiently than ever before by leveraging cutting-edge technology to do the footwork for you.

And healthcare revenue cycle management is no exception.

Despite obstacles such as cost and security, RCM departments continue to push toward automated solutions to improve the patient experience and maximize reimbursements. Specific trends in 2017 have included enterprise resource planning systems, cloud applications, data analytics and outsourcing – strategies all intended to increase the efficiency and accuracy of the RCM process.

Investment in enterprise resource planning systems

In your RCM department, your staff need to budget their time and resources effectively to ensure that claims are completed correctly and on time. Often, that can mean learning through trial-and-error attempts at coordinating team members and tasks.

Luckily, there's a better way.

Many organizations are opting to invest in enterprise resource planning systems to ensure that they're maximizing their workflow to ensure the highest possible reimbursement rates. According to a report on 2017 RCM trends by Black Book, 93 percent of CFOs believe that ERP is necessary to adequately achieve supply chain efficiency, price transparency and true costing in value-based care.

This type of automation in healthcare means that your staff have time to focus on the tasks that most require their attention, improving your department's ability to meet deadlines and increase reimbursements without the necessity of additional employees.

Cloud applications as the primary storage platform

In healthcare and beyond, the cloud is becoming an increasingly popular home for information storage. A McAfee white paper reported that 93 percent of organizations currently use cloud services and 74 percent store sensitive information in the public cloud.

"In RCM storing information in the cloud is quickly becoming the norm."

In RCM, storing information in the cloud is no longer novel – it's quickly becoming the norm. According to Black Book's 2017 Trend Report, more than 55 percent of CIOs are confident in their strategy for cloud applications.

But looking forward, these professionals now need to think about disaster recovery. The survey found that 83 percent of healthcare organizations don't have cloud storage that would allow them to recover information in the event of a disaster.

Cost-estimation through data analytics

When consumers walk into stores, the prices of each product or service are typically clearly labeled and customers know how much they'll pay before they step up to the register. So when it comes to medical billing, patients can become quickly frustrated over the lack of price transparency. Creating estimates involves coordination between billing departments, insurers and more.

To improve this process, some organizations are turning to cost-estimation solutions which use data analytics to not only give patients the cost information they want, but also aid healthcare groups in obtaining the data they need for the successful claims resolution that leads to increased reimbursement rates.

Strategic use of RCM outsourcing

Throughout 2017, healthcare organizations have strategically used RCM outsourcing options to increase the success of their claims resolutions.

In fact, a report by Black Book predicted that the market for ambulatory and physician RCM outsourcing, as well as extended business office services, in the U.S. is expected to grow by 42 percent between Q4 2016 and Q1 2019.

"Rising healthcare expenditures and the complex technology or staffing requirements to succeed under value-based care is creating the urgent demand for cost-effective, technically advanced business office outsourcing solutions in physician practices across the country," said Doug Brown, managing partner of Black Book. "High-impact drivers of the physicians practice outsourcing market include the increasing emphasis on compliance and risk management, and the need for more efficient and cost effective processes,"

To learn more about how outsourcing your specialized claims, such as workers' compensation and motor vehicle accident, can help streamline your healthcare revenue cycle management department, contact PROMEDICAL today.

Post-health insurance finances burden for patients, study finds

doug@promedllc.com (PROMEDICAL ) — Sat, 14 Sep 2019 13:41:42 GMT

A recent study by TransUnion Healthcare found that PBAI challenges continue to grow

Hospitals have faced issues with managing patient balances after insurance usage for years. However, a recent study by TransUnion Healthcare found the challenge continues to grow. Not only is this issue impacting hospitals across the country, but it’s also making it more difficult for patients, posing a serious financial burden on those who can’t afford care costs.

PBAI increasing by the numbers

According to the analysis, total bill responsibility of patient balance after insurance (PBAI) rose from 8 percent in 2012 to 12.2 percent in 2017. Commercially insured patients saw bills rise from an average of $467 to $781, a substantial increase of 67 percent.

“The continued trend in costs is correlating to an increase in uncompensated care.”

Unfortunately, this continued trend in costs is correlating to an increase in uncompensated care, something that impacts both the patient and the provider, according to Jonathan Wiik, author of “Healthcare Revolution: The Patient is the New Payer” and principal for healthcare strategy at TransUnion Healthcare.

“It is becoming clear that patient balances after insurance is a major factor in increases in uncompensated care at the macro level,” said Wiik. “Higher out-of-pocket-costs from cost sharing has made patients responsible for an increasing percentage of the bill. Most patients simply cannot afford that, and hospitals need to make sure they’re actively engaging their patients to ensure they have funding mechanisms for the care needed. Tools like propensity to pay, charity scoring and others can help differentiate a patient’s willingness or ability to pay.”

Medicare patients see costs jump

Medicare patients are also struggling to pay deductibles and coinsurance. Hospitals and facilities are struggling to find a balance between reimbursement and patient responsibility due to this issue, according to John Yount, vice president of TransUnion Healthcare.

“Unpaid medical debt continues to pose challenges and the rise in uncompensated care further reflects the importance of implementing new solutions to prevent revenue leakage, which ultimately provides a better patient financial experience,” said Yount. “A solution to address Medicare Bad Debt reimbursement is another critical component in a hospital’s toolkit to ensure they’re managing to the increased PBAI.”

With the right plan in place, facilities can make better and smarter decisions toward decreasing the financial burden on patients.

Unpaid medical debt poses challenges on patients and the facility.

RCM companies can provide a solution

Making sure the correct payer is identified to maximize reimbursement can solve such issues faced by both the patient and healthcare facility — a good example being an injury from a motor vehicle accident or at work. This is one way to reduce the problem of bad debt exposure, allowing providers to decrease cases of uncompensated care.

Hospitals can benefit from outsourcing to a third-party revenue cycle management company like PROMEDICAL. With a technology-driven revenue cycle partner, you may reduce patient balances after insurance. This minimizes the bad debt and ensures your patients receive the quality care they need without worrying about the financial burden that follows.

Some of the core benefits of working with an RCM provider include a streamlined process, increased efficiency, reduced operating costs and an improved patient experience. There’s no need to rely on just the hospital’s revenue cycle professionals to take care of all revenue cycle management — hire a team of RCM professionals to reduce these tasks.

By partnering with PROMEDICAL, you can improve reimbursement, timely resolutions, and increased cash and, in turn, have more satisfied patients. Reach out to PROMEDICAL today to learn about the benefits of partnering with our team.

New advances facing worker’s compensation claims

doug@promedllc.com (PROMEDICAL ) — Sun, 01 Sep 2019 04:00:00 GMT

Worker’s compensation processes will likely change as new technology presents itself.

According to some, the worker's compensation claim process is in need of a change. Like many other new revolutions, that change seems to be coming courtesy of technology. The true benefits, though, will only arise from a merge of new hardware and informed expertise behind it. Vendors should consider the double advantages of combining these two factors for consistent management.

These advances are poised to alter the compensation claims pipeline. With these changes, vendors could see standards for fast service rise and incentives for better management grow. PROMEDICAL is part of the new trend toward billing with an emphasis on best practices for the company.

Wearable devices

Imagine a compensation claim that begins with a call from a worker's wrist. Or an employee using the same device to track an ongoing condition for insurance purposes. With advances in wearable technology, this is closer than some realize. Taking advantage of the new technology available will create a clear line between the incident itself and the medical partners that have to be a party to each transaction.

In a way, the industry has already reached this point. PROMEDICAL's mobile-friendly solutions are just a smartphone tap away for users, and that's a process that could only become more streamlined as newer devices become more available.

The basic principle seems to be similar: Put web portal access in a user's hands, and keep the connection strong from there. Always-on technology brings the additional chance to cut out unnecessary complexity and get a real-time reading from each patient.

A "blue button"

Health insurers are familiar with the concept of the "blue button," a single way to engage with health benefits online through a portal or other streamlined access point. It's a nexus point that theoretically brings all of the facets of electronic health into a single gateway.

"PROMEDICAL's mobile-friendly solutions are just a smartphone tap away for users."

Thomas Lynch of consultancy Lynch Ryan spoke about this in an Insurance Journal article from 2014. He mentioned that the "blue button" idea had not made its way to the Property & Casualty insurance industry as of then.

"Even now, today, the usual way is that when you have a claim, you'll go online and file a report online or you'll make a phone call," he said. "Why couldn't you take out your smartphone, have a voice activated app that could allow you to report directly into your carrier's system which would, in real time, display for a claims adjuster?"

Having the staff and the systems to deliver better claims workflow will double the resources businesses have for themselves.

Time to evolve

Now, the workers compensation claims process has the chance to move forward. Contact PROMEDICAL to learn more about our efficiency-focused methods for embracing new changes.

The 4 core benefits of working with an RCM provider

doug@promedllc.com (PROMEDICAL ) — Wed, 21 Aug 2019 04:00:00 GMT

Just as doctors and nurses specialize in care, your RCM should be handled by professionals well versed in the industry.

In the healthcare sector, revenue cycle management is an extremely important task to handle – and do so in a cost- and energy-efficient manner. Ensuring you make clean claims while also saving time, money and efforts that can be used towards caring for more patients is vital for all hospitals today. Just as doctors and nurses specialize in care, your RCM needs should be taken care of by professionals well-versed in the industry.

With that in mind, here are the four core benefits of working with an RCM provider:

1. A streamlined process

One of the top advantages of utilizing a RCM partner is the streamlined process that comes with it. The days of attempting to manage all revenue cycle tasks can be over and a RCM company will ensure smooth, streamlined process.

2. Increased efficiency

As stated by Customer Think, healthcare leaders rely on a steady workflow, security and stability to make the best use of their valuable time and resources. Without an RCM provider, executives and decision-makers at these facilities may find it more difficult to manage time wisely and ensure quality productivity on a daily basis. Working with a revenue cycle management company introduces your facility to customized processes by financial class, in turn allowing your staff members to decrease the time spent organizing billing and collecting payments and focus on other areas of your accounts receivable instead.

The pros of outsourcing your revenue cycle management are numerous.

"Healthcare leaders rely on a steady workflow, security and stability."

3. Reduced operating costs

Your revenue cycle management system should be generating cash flow for your facility, plain and simple. With a third-party RCM provider, you can enhance cash flow all while reducing operating costs. In fact, according to the Advanced Data Systems Corporation, outsourcing your medical billing department can amount to as much as a 30 percent revenue boost. Engaging an RCM company who uses quality, reliable technology means more money for your facility and less money spent taking care of the tasks in-house.

4. An improved patient experience

Your patients expect your doctors, nurses and hospital staff to be well educated and fully equipped to provide care. They expect the same from your billing department. By hiring an RCM provider, you can rely on a group of experts to not only provide a superior patient experience but also work with the payer community to expedite resolutions. A revenue cycle management company should always work to enhance the hospital's brand.

Don't put the pressure of taking care of revenue cycle management on the shoulders of your hospital staff workers. Instead, work with PROMEDICAL for your RCM services. Since 1995, PROMEDICAL has provided the healthcare community with a client-focused, technology-driven revenue cycle partner. By working with us, you can help your facility prioritize proper reimbursement methods to ensure timely resolutions and increased cash flow.

Request more information on partnering with PROMEDICAL today.

5 Common Hospital RCM Pain Points – and How to Address Them

doug@promedllc.com (PROMEDICAL ) — Sun, 14 Jul 2019 04:00:00 GMT

In the hospital setting, revenue cycle management is an integral – but complicated – component of ensuring an organization runs efficiently and effectively.

It's no secret that revenue cycle management is an integral – but complicated – component of ensuring an organization runs efficiently and effectively. But knowledge alone doesn't solve the RCM headaches healthcare decision-makers face every day.

The following are five pain points frequently experienced in hospital revenue cycle management – and solutions for addressing them before they take a toll on your organization's bottom line.

1. Errors in Billing and Collection

Though any hospital RCM department likely recognizes that preventing errors is a major challenge in billing and collection, they may underestimate the frequency of these mistakes. According to Becker's Hospital Review, professionals estimate that errors occur in as much as 80 percent of medical bills . And the Medical Billing Advocates of America reported that the number is on the rise.

"We are seeing a lot of the error types escalating, especially in the hospital area. We have such a complex billing system, that it leaves so much room for errors to occur on medical bills, and that is what we are seeing," Medical Billing Advocates of America founder and CEO Pat Palmer told the radio station New Jersey 101.5 FM.

When processes are rushed in an effort to ensure that the proper forms are submitted at the right time, revenue cycle performance can obviously take a hit. But it's not just about the bottom line. Errors in billing and collection can negatively impact the patient experience, hurting the hospital's reputation in an increasingly consumer-driven market where patients can choose to pursue care from a competitor.

2. Challenges Created by HIT

From robots that assist with surgeries to electronic health records that store patient information, tech is involved of a patient's episode of care – including financial arrangements. However, sometimes these advances also bring their fair share of challenges, particularly in terms of billing. Many organizations lack the HIT infrastructure to properly monitor and complete the RCM process effectively and efficiently, especially considering the diverse demands of ICD-10, interoperability requirements and other technical components of health IT present in hospital billing.

Furthermore, some hospitals don't have the staff they need to address the implantation and use of these HIT RCM processes. For example, according to the U.S. Bureau of Labor Statistics, demand for medical records and health information technicians is expected to rise by 15 percent between 2014 and 2024. Over the last decade, hospitals have struggled to fill positions to meet this growing demand.

The RCM process takes involvement from a variety of key players in a healthcare system, which can create significant challenges.

3. Lack of Training and Resources

Even if an organization has the staff necessary to successfully navigate the RCM process, a great deal of training is required to ensure compliancy. However, given the high volume demands of the billing process, finding the time for proper training can be a challenge – not to mention expensive. Many hospitals consequently struggle to ensure that their RCM department receives the instruction, support and resources it needs to function efficiently and accurately.

4. Failure to Supervise Entire Claims Process

Hospital revenue cycle management isn't a short process, and failure to monitor the operation from beginning to end can result in costly errors. Mistakes can be made as early as when patient information is recorded during scheduling and registration, or later on when services are translated into ICD-10 codes and claims are sent to payers. When the whole process isn't monitored properly, it can be difficult – and time consuming – to determine where the problem occurred when a claim is denied.

5. Variety of Claims in RCM

There's no one-size-fits-all in medical billing. Patients have different types of procedures and insurance, and each of these situations has numerous requirements of their own. If an RCM department needs to address every type of claim, staff members may be forced to spend extra time working on those that are more complicated or otherwise out of the ordinary.

For instance, one of the more challenging components of the RCM process is auto insurance claims. These claims often occur with out-of-state residents, who may seek treatment in a different state than the one in which they're insured. Because different states have different requirements, the claims process can be complicated and confusing for hospital staff. Consequently, automotive claims – as well as workers' compensation billing – provide particular challenges that a hospital's RCM department may not be equipped to address.

While these pain points pose a significant challenge to hospitals, there is a revenue cycle management solution that can help all five: outsourcing components of the process. Whether you choose to find a vendor who can assist with a certain type of claim or the majority of the operation, seeking outside assistance can help your RCM department run more efficiently and avoid costly errors.

Cars are getting smarter: Your revenue cycle should too

doug@promedllc.com (PROMEDICAL ) — Thu, 27 Jun 2019 04:00:00 GMT

The auto accident claims process can modernize to match advances in smart cars.

Car manufacturers are banking a lot on the smart autos of the future. It's too early to know for certain how new technology will change the norm for car accident claims. However, it's just early enough to invest in a healthcare revenue cycle vendor that will be just as quick, intelligent and comprehensive as the wired world will demand.

What the technology could do

The chief explanation for the advances of smart cars is their life-saving potential. In March, the National Highway Traffic Safety Administration announced in a press release that it would research proper safety standards for automated cars. Some of the efforts include following a $3.9 billion proposal for more auto advances from President Barack Obama and a plan to re-examine current regulations.

In the same statement, Anthony Foxx, secretary of transportation, commented on the opportunities of automated cars.

"We are witnessing a revolution in auto technology that has the potential to save thousands of lives," Foxx said. "In order to achieve that potential, we need to establish guidelines for manufacturers that clearly outline how we expect automated vehicles to function – not only safely, but more safely – on our roads."

"An in-vehicle sensor and a mobile phone app could automatically alert responders after a collision."

What will happen to insurance

There are already plenty of predictions about the impact of smart cars on auto insurance. According to Swiss RE, the next four years alone could see insurance premiums in countries around the world decrease by $20 billion. The Guardian reported on these figures, as well as the 1.5 million smart cars registered in 2015. Autonomous braking, lane keeping assist and parking technology are all poised to reduce accidents.

In addition, the car itself could become a key tool in accident reporting. General Reinsurance AG's Achim Bosch posted about these advances in March. While he noted that insurance has not taken advantage of this as much as it could, he did describe the mobile-friendly systems used to report accidents instantly.

Under this system, an in-vehicle sensor and a mobile phone app could automatically alert responders after a collision. Bosch said that this effort is also a precursor to the eCall initiative, an EU-wide network that will be mandatory for cars in the region starting in 2018.

PROMEDICAL: The need for instant response

This is where PROMEDICAL's solutions can help businesses stay alert. The benefits of the smart car world will hinge around fast, accurate service. Health insurers should play their part by investing in a suitable billing system.

PROMEDICAL's proprietary billing doesn't solely rely on artificial intelligence, but instead blends it with organic staff expertise to serve each client specifically. Everyone involved in the claims process, from the policyholder to the insurance company, can communicate seamlessly with our smartphone-friendly app.

Visit our solutions page to read more, or learn how to contact us here.

The Difference Between RCM Applications and Solutions (And Why it Matters)

doug@promedllc.com (PROMEDICAL ) — Wed, 12 Jun 2019 04:00:00 GMT

Revenue cycle management applications are software designed to support hospital RCM operations. In contrast, RCM solutions augment RCM technology with account management and consulting.

Here's why this distinction matters: RCM applications can neither deliver nor utilize knowledge. They can guide the communication of knowledge, but they're incapable of analyzing situations, identifying the next best action and executing that action.

Sure, many applications include some sort of machine learning logic. However, such technology, for the most part, is limited to making helpful recommendations as to which steps an accounts receivable department should take after a workers' compensation provider denies a claim.

RCM solutions are typically better choices than RCM applications because only humans can navigate complex situations, especially when those situations are a result of complicated legal conditions. In addition, regulations can render relatively new, capable software obsolete.

"93% of hospitals CFOs want to get rid of technology that isn't producing an ROI."

Hospitals Replacing RCM Applications

Last year, Black Book surveyed more than 5,000 health care professionals who were using RCM software . The researchers discovered that 85 percent of participants were either assessing their RCM applications' capabilities or considering replacing those systems altogether.

The purpose of those assessments was to determine whether or not existing RCM technologies could help them manage value-based reimbursement. In fact, 93 percent of CFOs working in health organizations maintained they want to get rid of RCM, financial and coding technology that isn't producing a return on investment.

One of the findings noted that 71 percent of care providers "have not selected end-to-end technology vendors to move towards value-based reimbursements." As a result, many hospitals are turning towards outsourced RCM consultants to guide them through the transition of value-based care.

Doug Brown, managing partner at Black Book, noted that hospital leaders are trying to transform how they approach the revenue cycle:

"As reimbursements come under pressure and costs keep rising, provider CFOs will face unparalleled pressure over the next year to preserve financial solvency, increase productivities in care delivery, implement regulatory mandates and reduce RCM expenses associated with getting paid."

How can RCM solutions help those CFOs reach their goals?

What Makes an RCM Solution?

Identifying how RCM solutions will help hospitals transition to value-based care partly involves assessing how they work.

The typical RCM solution consists of consultants, legal experts, coding specialists and proprietary technology. The latter exists across vendor operations: The hospitals never see the systems themselves. The solution itself is a comprehensive service offered by an RCM partner.

A solution is, in its own way, an infrastructure. Just as a series of highways, tunnels and roads make up a city's transportation infrastructure, an RCM solution consists of the resources required to navigate complex billing issues.

For example, acquiring reimbursement from auto carriers is a common pain point in hospital billing departments. This is due to the fact that each state has its own laws regarding who is the prime payer after an accident.

Digging deeper into the issue, there are 12 states in the U.S. with no-fault auto insurance laws. Under no-fault laws, auto-carriers are always the prime payers when drivers are injured during accidents in no-fault states, regardless of whether those drivers were at fault.

However, what happens when a driver from a fault state is in an accident in a no-fault state? In this instance, the driver's auto carrier may deny a claim as the prime payer.

RCM solutions are designed to handle such circumstances. They draw on the understanding of partner-side experts who are knowledgeable of how state laws affect auto carrier and workers' compensation reimbursement . This knowledge can be incredibly valuable, especially during times of transition.

Knowing when to outsource your revenue cycle management

doug@promedllc.com (PROMEDICAL ) — Tue, 14 May 2019 04:00:00 GMT

If your facility is considering outsourcing revenue cycle management, here are indicators that it may be the best decision moving forward.

Hospitals and healthcare providers have dozens of systems-related responsibilities: from patient check-ins to behind-the-scenes documentation. For most facilities, orchestrating the revenue cycle management can be a relentless drain on resources.

But with so much on their plates, more hospitals are considering outsourcing their RCM – or at least a part of it. According to a recent survey by Black Book Research, 80 percent of hospital leaders made up of C-suite, hospital boards and senior managers plan to contract out for revenue cycle management by next year.

Outsourcing of revenue cycle management is becoming more necessary than ever. If your facility is considering this route, here are a few indicators that it may be the best decision moving forward:

1. Documentation processes seem disorganized

Organization is critical to successful revenue cycle management. If there isn't smooth coordination, your facility may have trouble translating services into billing codes, generating professional claims and more.

RCM must always be given a high priority; you should dedicate a team to make sure front end and billing processes are done as accurately and efficiently as possible. Contracting out RCM ensures all factors will be taken care of and positively impact the businesses' key performance indicators.

Hospital leaders recognize the benefits of outsourcing revenue cycle management.

2. KPIs are underperforming

Your facility may need assistance with RCM if KPIs include bad debt, charity, cash-to-net revenue, percentage of claims made on first pass and more. Certainly, some hospitals may disregard the idea of hiring a third-party organization to take care of RCM due to monetary reasons, but long-run revenue will outweigh upfront costs of outsourcing , according to Melissa Scott, director of advisory services at a healthcare technology company.

3. Technology for RCM is underwhelming

As technology continues to transform and digital advancements emerge, businesses are relying on automation services now more than ever. Hospitals may invest in a piece of technology to handle RCM, but trusting solely in the system can potentially hurt the organization's bottom line.

According to Healthcare Finance, relying on technology can hinder overall performance and break up the steady workflow established by staff members when systems go down.

"Relying on technology can hinder overall performance."

Instead, hospitals and facilities should use technology as a complementary resource to a third-party RCM team. Hiring professionals to take care of this responsibility can ensure nothing falls through the cracks while keeping the workflow of key staff members steady.

All in all, outsourcing RCM improves quality and patient safety and encourages enhancement in the company's bottom line.

If your facility is facing the previously stated issues, it may be time to consider outsourcing. PROMEDICAL is a national healthcare revenue cycle management company working to provide the healthcare community with a client-focused and technology-driven revenue cycle partner. By partnering with PROMEDICAL, you can ensure proper reimbursement, timely resolutions and increased revenue for your facility.

For more information about our services, contact PROMEDICAL today.

New report shows weaknesses of hospital pagers

doug@promedllc.com (PROMEDICAL ) — Fri, 05 Apr 2019 04:00:00 GMT

Many medical professionals still rely on pagers for communication on-site.

Updating technology can keep hospitals ready to handle the latest industry-related changes. Trend Micro recently highlighted one particular device that's still in use in healthcare settings despite fading out of the public consciousness years ago.

As the report stated, pagers have been in use for far longer in healthcare than in the general business world and now pose a possible security problem , since they predate many of the common digital privacy protections organizations are familiar with. In particular, pagers don't have the encryption capabilities of many modern devices.

However, since mobile coverage is still an issue for many facilities, the pager is seen as a simple way to communicate that uses low amounts of power and can be brought into high-stress situations, such as operating rooms. The report advocated for better encryption and authentication as a remedy, as well as enforcing best practices to keep users from transmitting multiple personal health information factors.

"Pagers don't have the encryption capabilities that modern devices have."

Other research also confirms the large presence that pagers still have for doctors. Research from Frost & Sullivan, which appeared in The Boston Globe this February, said that pagers are still necessary in around 85 percent of hospitals.

The source also spoke to CIO John Halamka of Beth Israel Deaconess Medical Center: He mentioned that pagers still work when cellular devices are "shut off," as they were during the Boston Marathon bombing in 2013. Despite this, the drive for modernization may replace pagers with more secure messaging methods.

PROMEDICAL is a national healthcare revenue cycle management company. Since 1995, we have provided the healthcare community with a client- focused, technology driven, revenue cycle partner. Our third party liability solutions include workers' compensation and motor vehicle accident billing. A partnership with PROMEDICAL ensures proper reimbursement, timely resolutions and increased cash.

5 Signs You Need to Outsource Your Revenue Cycle Management

doug@promedllc.com (PROMEDICAL ) — Tue, 27 Nov 2018 05:00:00 GMT

Should you outsource your revenue cycle management operations? Here are five signs that you may benefit from doing so.

Last year, Black Book discovered that the revenue cycle management outsourcing market is growing 42 percent annually .

Should you follow the path of other hospitals and work with an RCM partner? It depends on what your current RCM process looks like. Here are five symptoms that indicate you should outsource:

1. You Can't Get Costs Under Control

If you consistently struggle to reduce your hospital's RCM costs, seek partners capable of identifying processes that stress your budget, such as:

EHR redaction: Removing sensitive information from patient health records before sending them to payers.
Utilization review: Reviewing the services the patient received and assessing which payers should reimburse the hospital for those treatments.
Point-of-service registration: Gathering information from the patient regarding how he or she sustained an injury as well as confirming coverage.

Inefficiencies and redundancies may exist across these and other RCM steps, but your in-house staff likely neither has the time nor perspective to clarify and rectify such issues.

2. RCM Technology Can Do More Harm Than Good

Some RCM applications do introduce recognizable improvements, but there are also many that exacerbate hospital revenue cycle challenges.

For example, after you buy a license to use an RCM application, it may be up to you to train people how to use the software. In addition, the system itself may force your department into a workflow which does not complement existing operations.

The point isn't to avoid RCM technology altogether. Instead, you simply need to carefully assess which technologies are the best fit for your business. Here are a few questions to ask:

Does the provider offer consultation in addition to RCM technology?
Is on-site training a part of the agreement?
Can the provider assist you with installing the software?

"For every complex denial, the average institution spends $5,427."

3. Workers' Comp Frequently Deny Claims

The tricky thing about managing workers' compensation claims is that each state has different fee schedules. On top of that, in-house A/R departments have to navigate jurisdictional payment problems and the manner in which workers' comp providers (WCs) structure policies.

As a result, many in-house teams don't know what sort of information WCs need to deliver reimbursement. Denials can add up quickly, too.

A survey from the American Hospital Association analyzed the average costs hospitals typically encountered when handling recovery audit contractor denials . The research found that for every complex denial, the average institution spent $5,427. That's more than twice of what it costs to treat a broken leg without insurance, according to Cost Helper.

4. Your Time-to-Collect Rate is Long

If it takes a long time for you to receive reimbursement from payers, you're not alone. Black Book found 96 percent of RCM leaders working in hospitals experienced inefficient billing processes. All of the survey participants maintained that they chose to outsource their RCM processes due to excessive time-to-collect rates and dropped collections.

RCM partners reduce time to collect by:

Understanding payers' legal obligations under statewide regulations.
Validating patient information post-registration and pre-billing.
Tracking claims metrics and spotting inefficiencies.
Leveraging existing relationships with payers.
Repricing claims based on fee schedules or contracts.

5. You're Launching a New Practice

Are you a physician opening up your own practice? All of the physicians who participated in the Black Book study said they were seeking to outsource their billing and claims management operations.

Why not manage it yourself? Treating patients is what you know best. As you probably know, receiving reimbursement isn't as simple as sending a bill to a payer.

This is especially the case in circumstances where a resident from another state gets into a car accident. Determining which auto carrier to bill isn't something you have the time to deal with, especially on top of all of the other demands associated with your business.

Outsourcing is usually a solid option, but be critical of the RCM partners you vet. Make sure the individuals behind their operations know how to handle the nuances you can't afford to tackle on your own.

GAO report gives security recommendations

doug@promedllc.com (PROMEDICAL ) — Wed, 24 Oct 2018 04:00:00 GMT

A new report examined the role of HHS security in recent years.

Following the various HIPAA rules laid out by the government has been a main pillar of hospital security for years. However, because of electronic healthcare breaches, hospitals may face challenges that the current rules don't adequately cover. This August, the Government Accountability Office released a report asserting that the Department of Health and Human Services " Needs to Strengthen Security and Privacy Guidance and Oversight. "

While the report acknowledged the benefits of electronic health information, it also addressed the "fragmentation" within the industry, raising the possibility of risks. Using HHS data, the report also noted that the number of reported health IT breaches affecting the records of at least 500 people has actually increased, from 0 in 2009 to 56 last year. 2015 also included more than 113 million compromised records in this level of breach.

"The number of reported health IT breaches affecting the records of at least 500 people has increased."

Hospitals know the differences between the HIPAA Privacy and Security Rules, both of which have been published for more than 10 years. In light of several recent breach events, the source made several recommendations for the HHS. These range from improving the assistance it provides to covered entities to gauging its audits effectively with new metrics.

HIPAA not only has to evolve to meet new breach threats, but new technology as well. Earlier this month, HHS released cloud guidance for using health data in these digital spaces. According to FCW, HIPAA strictures can still apply to cloud vendors that encrypt their data, which may not be a foolproof protection against malware.

PROMEDICAL is a national healthcare revenue cycle management company. Since 1995, we have provided the healthcare community with a client- focused, technology driven, revenue cycle partner. Our third party liability solutions include workers compensation and motor vehicle accident billing. A partnership with PROMEDICAL ensures proper reimbursement, timely resolutions and increased cash.

Survey: Patients highly value quality hospital experience

doug@promedllc.com (PROMEDICAL ) — Fri, 05 Oct 2018 13:54:33 GMT

A new study finds the overwhelming majority of patients want high-quality experiences during their hospital visits.

Ensuring your patients have positive experiences at your hospital is critical. Patients don't solely rely on their visit with the doctor or specialist to be positive. They also take note of their overall satisfaction from the moment they step into the waiting room up until they go over payment plans with the billing department.

To better understand the importance of patient engagement and overall satisfaction, let's examine some of the key takeaways from the Beryl Institute's recently released report , "Consumer Perspectives on Patient Experience 2018: Insights and Opportunities for Action."

Key findings

Based on information gathered among 2,000 individuals of different demographics and economic levels living in the U.S., U.K., Canada, Australia and the Philippines, the majority of the participants certainly understand the value of a high-quality patient experience.

According to the study, 59 percent of the participants believe patient experience is extremely important, while 32 percent believes it's very important. Slightly less than 10 percent of the individuals surveyed see patient experience as somewhat important.

Breaking down the reasoning behind why the patient experience is so vital, 78 percent of respondents agreed that the top reason was that personal health and well-being is very important to them. Some of the other key signifiers included:

"I want to know that my physical needs are being taken seriously" – 72 percent
"Good PX contributes to my healing/goods healthcare outcomes" – 69 percent
"I want/deserve to be treated with respect" – 68 percent

By the end of the positive patient experience, 69 percent of respondents agreed that the most important outcome is that their overall health ultimately improves. Meanwhile, 68 percent said the ideal outcome was receiving care that was delivered safely, and 66 percent said achieving positive health outcomes was the top priority after receiving care.

Patients at your hospital need to know they'll be taken care of

Understanding the experience segments

To get a better idea of what participants considered to be apart of their experience, the report outlined aspects based on three different segments: the people, process and place.

People: The care team listens to you, communicates clearly, treats you with courtesy and respect, gives you confidence in their abilities, takes your pain seriously, provides a clear plan of care and why, asks questions and understands your needs and more.
Process: The care team makes it simple to schedule an appointment within a reasonable time period, discharge process in which your treatment plan in care is clearly explained, provide a billing process that is clear, understandable and respectful and more.
Place: The care facility is clean and comfortable, quiet and peaceful, convenient to access, easy to navigate, provides amenities and more.

Of these segments, 56 percent believe all parts of the "people" aspect is the highest priority. Finding professionals that listen to the consumer, communicate clearly and treat the consumer with courtesy and respect are more important to maintaining a positive patient experience.

How PROMEDICAL can help your hospital

One of the key aspects of providing the best patient experience under the process segment highlighted in the report is providing a billing experience that is respectful and simple to understand.

By outsourcing to a national healthcare revenue cycle management company like PROMEDICAL, you can rely on highly skilled professionals and solutions to ensure proper reimbursement, timely resolutions and increased cash all while focusing on maintaining a positive relationship with patients.

For the 5th Time, PROMEDICAL Appears on the Inc. 5000 List, Ranking No. 4335 with Three-Year Sales Growth of 77% and is added to the Honor Roll as a Five-Time Honoree

doug@promedllc.com (PROMEDICAL ) — Thu, 23 Aug 2018 15:23:11 GMT

Inc. magazine ranked PROMEDICAL NO. 4335 on its 37th annual Inc. 5000, the most prestigious ranking of the nation’s fastest-growing private companies. PROMEDICAL was also added to the Honor Roll as a Five-Time Honoree. The list represents a unique look at the most successful companies within the American economy’s most dynamic segment— its independent small businesses. Companies such as Microsoft, Dell, Domino’s Pizza, Pandora, Timberland, LinkedIn, Yelp, Zillow, and many other well-known names gained their first national exposure as honorees of the Inc. 5000.

“We are excited and honored to be on the list for the 5th year in a row and now to be on the Honor Roll as a Five-Time Honoree. The growth that we have experienced over the last 3 years would not have been possible without the dedicated work of our highly experienced staff, the continued evolution of our technology and the strong partnerships we have created in the health care community” said Doug Lucente, CEO of PROMEDICAL.

About Inc. 5000:

The Inc. 5000 is a list of the fastest-growing private companies in the nation. Started in 1982, this prestigious list of the nation’s most successful private companies has become the hallmark of entrepreneurial success. The Inc. 5000 Conference & Awards Ceremony is an annual event that celebrates their remarkable achievements. The event also offers informative workshops, celebrated keynote speakers, and evening functions.

Report: 98 percent of hospitals understand need for healthcare outsourcing

doug@promedllc.com (PROMEDICAL ) — Fri, 29 Jun 2018 04:00:00 GMT

It’s become apparent to many hospitals that they need to outsource certain services.

The average hospital is overwhelmed with medical professionals and healthcare administrators alike constantly doing everything within their power to serve all patients in the best possible manner.

But within that environment, mistakes can be made and processes can be overlooked – more often than anyone with a passion for working in healthcare would want. When errors occur, they can often be attributed in whole or part to overexertion and exhaustion.

"Hospitals can notably benefit from the assistance provided by third-party outsourcing."

While understandable on a human level, hospitals can't afford to jeopardize patient care and experience in any way. Recent research points out in great detail the potential dangers of overextending administrative staff – as well as the possible benefits of outsourcing healthcare revenue cycle management and other functions.

Costs expected to steadily rise

Black Book Market Research found a great deal of compelling evidence that illustrates the value outsourcing can bring in the medical sphere , not least of which is cost reduction. This is particularly relevant given the finding that headlines its survey of leading healthcare management figures: By 2022, it's quite possible that hospitals will have to cut costs by at least 24 percent solely to break even on their expenses, let alone profit.

No matter what services may be cut, it's all but guaranteed that this would lead to a decline in the patient experience, thus potentially limiting the likelihood of patients trusting institutions with their health in the future, or recommending them to friends and family.

Also, with the State of Population Health survey by Numerof & Associates finding that 54 percent of healthcare organizations bring in only 10 percent of their income through risk-based models, there is even more pressure on facilities to lower costs.

Most leaders at medical institutions understand that outsourcing some tasks is a must.

Tangible value to outsourcing

Among nearly all of the 709 managers, C-suite company leaders and other respondents to the Black Book survey, the need for outsourcing in healthcare was made perfectly clear, as 98 percent of them said they were either actively considering adopting such services or had already done so. Part of this, as noted by Black Book President Doug Brown, is the good reputation of outsourced services within the field.

"Outsourcing in the healthcare industry doesn't get the same bad rap other sectors experience such as banking, insurance, tech and call centers where negative stereotypes associated with offshoring and/or full functioning outsourcing were largely misinformed," Brown explained. "In hospitals, there is a developed understanding of the broad spectrum of outsourcing options and how to manage vendors."

Because of the cost-reduction potential inherent in outsourcing nonclinical responsibilities such as billing, some hospitals and clinics are adopting it for various clinical purposes as well. Some of these include operation of teleradiology and medical imaging equipment, as well as emergency care and anesthesiology.

PROMEDICAL has been an outsourcing partner with health systems and hospitals since 1995 to provide workers' compensation and motor vehicle accident billing. Leverage PROMEDICAL's technology and expertise to ensure proper reimbursement, timely resolutions, increased cash and a superior patient experience all while giving your staff more time to dedicate to other important responsibilities.

Unify front- and back-end RCM to improve efficiency – and ROI

doug@promedllc.com (PROMEDICAL ) — Mon, 04 Jun 2018 17:08:10 GMT

A unified RCM platform is of vital importance to any medical organization.

There's no denying the immense value and importance of the worldwide healthcare revenue cycle management market.

According to a report by Data Bridge Market Research, this segment should account for about $137 billion in revenue for healthcare providers by 2024. Services-based RCM makes up the bulk of this field and will account for $50.9 billion in earnings for these industry entities by 2024.

The reason for this, of course, is the preponderance of issues that can present themselves within the context of any hospital, clinic or other major healthcare organization – particularly when operations have become improperly siloed and disconnected.

"Problems can arise out of any siloing that separates front- and back-end operations in medical organizations."

The key to eliminating such siloes lies with uniting RCM functions across both front- and back-end systems. Doing so can help administrators within these facilities bring a greater sense of efficiency and efficacy to all operations within the healthcare revenue cycle.

Even better, unifying these operations can ultimately provide better experiences for both hospital staff and patients alike.

Isolation, knowledge gaps caused by separated operations

On the surface, one can perhaps understand why front- and back-end hospital operations would be distinctly separated from each other, even solely within the RCM sphere.

In the former segment, admissions, insurance coverage confirmation and other basic but essential information-gathering tasks take place.

Meanwhile, the back end involves things that can be considerably more complex: medical billing on macro and micro scales, claims and denials management, and various other necessary financial interactions between healthcare organizations and patients or payers.

The primary problem with keeping these two halves of RCM separate is the misunderstanding that the front end may have about the back end , and vice versa.

As pointed out by RevCycleIntelligence, front-end staff in siloed situations won't necessarily know as much about claims processing. At the same time, those working in the back-end trenches can lose touch with the patient-facing tasks that require a measure of empathy and understanding for different patients' needs.

Bringing them together, by contrast, can help all pockets of organizational staff expand their horizons and knowledge.

Combining front- and back-end RCM leads to both greater ROI and more efficient organizational processes.

Unification to improve efficiency

Rebecca Wright, vice president of strategic planning at Iroquois Memorial Hospital in Watseka, Illinois, commented further on the problem of siloing and the advantages of bringing front- and back-end operations together, in an interview with RevCycleIntelligence.

"In the past, it's always been focused on back-end or business office in collections, and we turned it on [its] head and looked at how we can push it more to the front end," Wright said. "Because we knew by pushing more of it to the front end, we could reduce overall costs for our organization and make outcomes a little bit better."

In the case of Wright's hospital, administrators moved all back-end operations to the front. This gambit succeeded and allowed for greater understanding of not only individual accounts, but also the overall revenue cycle and how everything connects.

Leveraging data essential to success

Easy access to all pertinent patient and claims information serves as the catalyst to all successful healthcare RCM operations – specifically, the control of that data to glean the seeds of actionable strategies.

There are numerous ways to capture and eventually utilize this data, and the specific choice of platform and methodology will vary between healthcare organizations.

According to Becker's Hospital Review, blockchain has emerged as a common technique for streamlining RCM , due mainly to its potential for predictive action. But implementing a new technology like blockchain may not be the right call for every healthcare provider.

What's most important is the ability to acquire all essential patient information – personal, financial and everything in between – at registration. Additionally, adopting a solution in which patient information can easily be matched with data from that individual's employer can provide further organization and efficacy to the process.

Global healthcare RCM market poised for significant growth

doug@promedllc.com (PROMEDICAL ) — Mon, 16 Apr 2018 13:47:13 GMT

Tools for proper oversight of the healthcare revenue cycle and better accounting across the broad spectrum of a medical organization’s financial matters have established themselves, in recent months, as utterly invaluable to healthcare administrative personnel.

In a sector such as healthcare, change sometimes occurs at breakneck speed, and countless outside factors have considerable impact on the day-to-day execution of essential tasks. As a result, it can be undeniably beneficial and productive to embrace aspects of the field that display sure signs of stability. Tools for proper oversight of the healthcare revenue cycle and better accounting across the broad spectrum of a medical organization's financial matters have established themselves, in recent months, as utterly invaluable to healthcare administrative personnel.

"Healthcare administrators depend on efficient tools that can provide proper oversight of their revenue cycles."

A new report by Future Market Insights provided considerable insight into the positive development of the healthcare RCM software market. Administrators of hospital systems, clinics and other medical practices have embraced these solutions in significant numbers, driving growth, and those that haven't would serve themselves greatly by doing so soon.

Rapid growth expected through 2022

FMI predicted in its report that the global market for healthcare revenue cycle management software will expand at a compounded annual growth rate of 6.9 percent between 2017 and 2022. This increase should equate to $43.3 billion in revenue. Also, software solutions dedicated to managing medical billing and payment tasks will grow at an impressive CAGR of their own – 8.2 percent during the same forecast period – but should bring in less revenue, of about $5.84 billion.

Support services are expected to drive a great deal of this growth. An expanding share of healthcare providers are finding their internal staff overwhelmed by the sheer volume of claims and transactions that must be processed. Particularly in situations where medical facilities still rely on legacy software or hardware – or wish to upgrade their tools but experience delays, budget shortfalls and other roadblocks – care providers will likely take all the help they can get from third parties.

All told, FMI projected that hospitals will account for the biggest share of healthcare RCM software adoption through the aforementioned forecast period. Laboratories constituted the second-biggest adopters for these solutions, followed by clinics.

Healthcare RCM software solutions will remain a vital tool for care providers through the foreseeable future.

Cloud deployment will figure prominently in healthcare RCM market

In 2017 alone, healthcare RCM solutions based in the cloud accounted for revenues of approximately $27 billion. Given the manner in which cloud technologies have permeated most prominent industries throughout the global economy, their increased presence in healthcare should be little surprise. Coherent Market Insight noted that organizational advantages, data evaluation and accessibility are some of the prominent factors driving use of the cloud for RCM, billing, claims processing and other tangential administrative processes care providers must regularly handle.

Factors to keep an eye on

The CMI report pointed out that the simple fact of increasing hospitalization totals around the world – especially in fast-growing nations like India and China – will go a long way toward driving uses of agile healthcare RCM solutions. Additionally, as people are living longer and the senior-citizen population rises in the U.S. and many other countries, the need for care among these individuals, as well as the many products and services tangential to such care, will only rise over the next few decades.

In light of trends like this, which should increase the workload of all staff within medical facilities – from nursing to administration – it's critical for personnel on the back end of such operations to utilize every tool at their disposal to increase efficiency. Healthcare RCM solutions that provide automated data entry, consolidated task management, a wide variety of payment options for patients and opportunities for better communication can serve this purpose with remarkable efficacy.

How to improve your current revenue cycle management processes with enhanced data capture

doug@promedllc.com (PROMEDICAL ) — Mon, 19 Mar 2018 04:00:00 GMT

Ensuring this timeline is streamlined and runs smoothly means a strong revenue cycle management (RCM) process.

Hospital staff workers and healthcare providers are expected to capture information, manage and collect payments for services from patients from the moment they schedule an initial appointment for treatment up until they make the final payment on a remaining balance. Ensuring this timeline is streamlined means a strong revenue cycle management process.

In order to increase revenue in your facility, here are a few tips for improving your RCM processes:

1. Take advantage of emerging tools and resources

As the world of technology continues to transform, it's important for all industries – healthcare included – to pay attention to new digital advancements that could positively impact the workspace. Apple, for example, is an IT company that has been working on making its footprint in the healthcare sector since 2014 when it introduced health statistics tracking to iPhones , according to Healthcare Dive. Facebook has numerous healthcare ambitions, according to MedCity News, including ideas to improve patient engagement in hospitals and health systems through the digital platform. Healthcare providers and hospital staff employees should pay close attention to these up-and-coming tools and resources and utilize them as a means of improving RCM.

2. Match language to patient population

Language barriers can have a huge overall impact on the satisfaction of patients. Not only can such a cultural difference keep patients from communicating the level of care they desire, but it can also keep them from understanding their financial responsibility. One way to ensure your facility prioritizes defeating problems brought on by language barriers is by partnering with revenue cycle vendors that make taking down the language barrier a priority as well. Vendors that hire HIPAA-compliant interpreters and provide all communications in the necessary languages will provide a seamless continuation of the hospital's communication. These types of vendor partnerships create an excellent patient experience and correct reimbursements in a timely manner.

Keep in contact with insurance providers to verify patient information.

3. Reconsider lines of communication

Keeping in contact with patients ahead of their scheduled appointments is critical for reducing cancelations and no-shows. It's also a great way to ensure they're aware of balances and prepared to make payments as soon as necessary, including prior to appointments. To facilitate transparency and patient preparedness, reconsider the lines of communication you use. Professionals across the nation can agree that calling a landline to remind patients about an appointment may not always work – according to the CDC, 50.8 percent of the nation's households admit that they only use their cellular devices.

Be open to communicating with patients by sending reminders via text and email. These are more convenient options for keeping in touch and ensuring patients make it to their appointments.

4. Hold ongoing training in registration area

Initial training for front office staff and the billing department is critical during the hiring process, but it's even more important to consider ongoing instruction for employees working in the registration area. Processes and tools are always changing, and if staff members aren't asking the right questions, patients won't provide enough information which could lead to denials or problematic claims down the road. Look into ways to improve data capture by training employees in registration on a regular basis.

5. Leave it to the professionals

Instead of relying solely on your hospital revenue cycle staff members to handle the accounts receivable, incorporate outside professionals who specialize in revenue cycle management. PROMEDICAL is a national healthcare RCM company that has provided the healthcare community with a client and patient focused, technology-driven, revenue cycle partner since 1995. Services include workers' compensation and motor vehicle accident billing and provide faster resolutions, proper reimbursement and increased cash flow.

Increase Your Hospital Reimbursement Rates – Despite Declining National Numbers

doug@promedllc.com (PROMEDICAL ) — Wed, 06 Sep 2017 04:00:00 GMT

To maximize your organization’s reimbursement rate in revenue cycle management, you should be familiar with the average rates across the country as well as the factors which can influence these numbers.

As any hospital executive knows, the anticipated price of a procedure is not always the amount that a hospital receives once the account is settled. In fact, an increasing amount of data is revealing that the average reimbursement rate for an organization is more likely to be much lower, and dropping.

According to a December 2016 report by the American Hospital Association, reimbursements paid by Medicare and Medicaid in 2015 were $57.8 billion less than the cost of treating beneficiaries under those plans. And healthcare organizations run into similar problems when filing claims with private insurers. But with a little bit of intentionality and planning, you can reverse this trend in your own healthcare organization.

By cutting ineffective practices and increasing efficiency, your revenue cycle management department can help ensure that your organization is able to maximize its own reimbursements, despite low national numbers.

Strategies for Increasing Hospital Reimbursement Rates

There are a number of factors that contribute to low reimbursement rates in any healthcare organizations. One of the major causes is missing deadlines or making errors when submitting claims, something that is especially problematic for high-volume departments.

To maximize reimbursements, organizations need to increase efficiency. Sondra Akrin, vice president of Revenue Cycle Transformation at Hayes Management Consulting, told Becker's Hospital Review that groups should focus on eliminating revenue loss and leakage .

"Start by looking at write-offs for denials that you couldn't appeal because a process failed (i.e. timely filing) or you were missing critical data (i.e. authorization)," Akrin said. "These write-offs are essentially lost revenue and drive down your collection efficiency. By focusing on refining processes and ensuring appropriate upfront data collection can prevent or minimize the loss of revenue."

You should also consider outsourcing some or all of your revenue cycle management process.This can be especially beneficial for specialized claims, such as those involving workers' compensation and motor vehicle accidents, which take up a lot of your team's time but only represent a small part of your organization's revenue.

Working with a partner like PROMEDICAL can help to simplify your revenue cycle management process, allowing your staff members to focus their time and attention on efficiently handling the standard claims that have a larger impact on your bottom line.

Hospital RCM staff need to focus on increasing efficiency to improve reimbursement rates.

Average Hospital Reimbursement Rates

Working to maximize reimbursements is particularly important given that new data reveals consistently low rates across the U.S.

Though the American Academy of Family Physicians estimated the average rate of reimbursement in the U.S. to be between 35 to 40 percent, RelayHealth Financial's 2017 Revenue Cycle Index put the rate for hospitals much lower.

According to the data used by RelayHealth Financial, which was initially compiled by McKesson, the average hospital reimbursement rates for large, medium and small organizations are as follow:

Large Hospitals

Midwest: 29.88 percent
Pacific: 27.51 percent
South Central: 27.14 percent
Mountain: 25.36 percent
Northeast: 25.31 percent
Southeast: 24.48 percent
Northern Plains: 21.43 percent
Southern Plains: 20.97 percent

Medium Hospitals

Northern Plains: 30.89 percent
Midwest: 30.24 percent
Northeast: 29.41 percent
Pacific: 28.01 percent
Mountain: 26 percent
South Central: 25.52 percent
Southern Plains: 24.11 percent
Southeast: 23.22 percent

Small Hospitals

Midwest: 36.98 percent
Northern Plains: 35.51 percent
Mountain: 32.94 percent
Northeast: 32.84 percent
Southeast: 31.36 percent
Southern Plains: 30.06 percent
Pacific: 26.91 percent
South Central: 25.34 percent

As the data illustrates, the average reimbursement rates for hospitals, while low across the board, appear to decrease as the size of the organization increases. This is likely due to the fact that, as the number of claims rises, it exacerbates the challenges that an RCM department faces.

Whatever the size of your organization, increasing the efficiency of your RCM processes and outsourcing practices when necessary will help to ensure that you stay ahead of the curve.

For the 4th Time, PROMEDICAL Appears on the Inc. 5000 List, Ranking No. 2606 with Three-Year Sales Growth of 135%

doug@promedllc.com (PROMEDICAL ) — Wed, 16 Aug 2017 15:18:35 GMT

Inc. magazine today ranked PROMEDICAL NO. 2606 on its 36th annual Inc. 5000, the most prestigious ranking of the nation’s fastest-growing private companies. The list represents a unique look at the most successful companies within the American economy’s most dynamic segment— its independent small businesses. Companies such as Microsoft, Dell, Domino’s Pizza, Pandora, Timberland, LinkedIn, Yelp, Zillow, and many other well-known names gained their first national exposure as honorees of the Inc. 5000.

The 2017 Inc. 5000, unveiled online at Inc.com and in the September issue of Inc. (available on newsstands August 16) is the most competitive crop in the list’s history. The average company on the list achieved a three-year average growth of 481%. The Inc. 5000’s aggregate revenue is $206 billion, and the companies on the list collectively generated 619,500 jobs over the past three years. Complete results of the Inc. 5000, including company profiles and an interactive database that can be sorted by industry, region, and other criteria, can be found at www.inc.com/inc5000.

“We are excited and honored to be on the list for the 4th year in a row. The growth that we have experienced over the last 3 years would not have been possible without the dedicated work of our highly experienced staff, the continued evolution of our technology and the strong partnerships we have created in the health care community” said Doug Lucente, CEO of PROMEDICAL.

About Inc. 5000:

The ACA in the Southeast: Adapting to the New Landscape

doug@promedllc.com (PROMEDICAL ) — Fri, 03 Mar 2017 05:00:00 GMT

The southeast has largely reacted to the ACA differently than much of the country.

While the Affordable Care Act dramatically altered the healthcare landscape across the entire U.S., its impact has varied significantly between regions. Case in point: the Southeast.

With exchanges leaving, rates fluctuating and tax credits unused, hospitals in this region must meet goals, cut costs and streamline claims processes without overcomplicating things or losing time. To better adapt to this new but fast-changing environment, hospitals need to keep their work cycles manageable. Otherwise, the ACA’s particularly chaotic effect on the Southeast will lead to tremendous efficiency complications. Let’s take a closer look at four of the different ACA-related factors that could disrupt standard hospital performance in the Southeast.

Medicaid (un)expanded

While the ACA attempted to broaden the reach of Medicaid, the Supreme Court’ s decision in National Federation of Independent Business v. Sebelius ruled the federal government could not mandate that states accept this expansion – and states in the Southeast have proven particularly unwilling to embrace the extension voluntarily. In total, 31 states have expanded coverage under the ACA.

According to the Kaiser Family Foundation, most of the southern states , including the Carolinas, Florida, Georgia and Mississippi, opted out of these expansions. As of October 2016, the list also included further west states, such as Texas, Oklahoma and Missouri.

“To keep their work cycle manageable, hospitals should pay specific attention to workers compensation and auto accident medical billing processing.”

Insurers leaving the market

Buyers in the Southeast face the possibility of fewer—or at least different—choices for their areas given changes to the law and business coverage.

The Associated Press reported residents in Virginia may find themselves with only a single insure r. As many as 7 million people were thought to be either outside healthcare markets or ineligible for specific income-based assistance. Premiums are also set to go up by a full quarter on average in several southern states, and such a significant increase will inevitably cause major disruption throughout the healthcare sector.

New expectations in 2017

It’s impossible to avoid the way recent political events have also brought the future of the ACA and general healthcare coverage into question. President-elect Donald Trump and his surrogates have

openly criticized the Act and promised to repeal it.

However, Trump has also admitted to favoring certain aspects of the care model, and some have questioned how long it would take for Trump to accomplish his goal. Depending on whether his administration changes the act, states which currently opposed elements of the law could find themselves changing their minds if it takes a different form. In any event, Trump’s win has certainly put a question mark over the actual future of the law and whether it will be completely replaced. Given the current level of chaos surrounding the ACA in the Southeast, these unknowns pose even greater challenges for hospitals in this region than those in the rest of the country.

Finally, there’s the growth of different covered residents to contend with. Reuters recently reported on the more than 1 million members set to receive health insurance through exchanges in the coming year. While this is lower than anticipated, the government still expects 11.4 million people to sign up each month next year.

In those states where confusion reigns regarding the ACA—i.e. the Southeast—many people on these exchanges may not fully understand their coverage. MPB Online reported 22,000 insured Mississippi residents may be missing out on tax credit benefits for which they qualified, for example. This lack of clarity further complicates the claims process not just for patients, but for hospitals and insurers as well.

Simplifying when possible

Considering all of this, hospitals in the Southeast should look to streamline and cut down the costs of their operations wherever possible. One of the best options: outsourcing workers compensation and automotive insurance revenue cycle management to a dedicated partner. While these two areas represent a small portion of hospitals’ total revenue cycle, their level of complexity requires a disproportionate degree of expertise. Working with a partner like PROMEDICAL simplifies matters, minimizes the risk of missteps and maximizes claim success.

Infographic: What strong claims support can do for you

doug@promedllc.com (PROMEDICAL ) — Fri, 17 Feb 2017 05:00:00 GMT

Healthcare facilities will have serious claims processing concerns. Why not let a professional medical billing company handle them?

After an accident, time and accuracy are both crucial. The complicated healthcare revenue cycle, chance of error and difference in state laws gives healthcare facilities a lot of different areas to worry about.

As such, hospitals will have serious claims processing concerns. Why not let a professional medical billing company handle them?

PROMEDICAL can take on both workers' compensation and motor vehicle accident billing claims.With our expertise, experience and industry-leading solutions, you'll see:

Reduced expenses
Increased reimbursements
Accelerated cash flow

And more! Read the infographic below to learn more. And be sure to contact PROMEDICAL for your workers' compensation and motor vehicle accident claim needs.

PROMEDICAL hires Roze Seale as Regional Vice President of Sales, Southeast

doug@promedllc.com (PROMEDICAL ) — Mon, 13 Feb 2017 16:11:08 GMT

PROMEDICAL, a national healthcare revenue cycle management company that provides third-party liability solutions including workers’ compensation and motor vehicle accident billing is pleased to announce the hiring of Roze Seale as Regional Vice President of Sales, Southeast territory.

“Roze is an excellent fit for PROMEDICAL as we continue to expand nationally. She has the skills and knowledge to understand where we can support healthcare providers”, said Doug Lucente, CEO PROMEDICAL.

Roze joins the PROMEDICAL team managing the Southeast region territory, working remotely from Mobile, AL. She is a healthcare industry veteran with extensive experience understanding the challenges faced by healthcare providers and developing innovative solutions to meet those needs. “Roze is an excellent fit for PROMEDICAL as we continue to expand nationally. She has the skills and knowledge to understand where we can support healthcare providers. We are committed to providing unprecedented customized client service, innovative technology and unparalleled results,” said Doug Lucente, CEO of PROMEDICAL.

“I am so pleased to join the PROMEDICAL team and know we can be a strong partner providing exceptional technology and expertise to the Southeast market. PROMEDICAL has a twenty year history of success providing industry defining solutions,” said Roze Seale.

For additional information on Roze Seale or any other PROMEDICAL related information, please contact Helen Chiasson helen.chiasson@promedllc.com.

Following good claims practices after a major disaster

doug@promedllc.com (PROMEDICAL ) — Tue, 20 Sep 2016 04:00:00 GMT

The capture of information at hospital registration matters for the revenue cycle after a natural disaster.

This summer saw multiple cases of significant storm events. While healthcare providers can be under enormous pressure during most cases, storm aftermath requires special attention to detail. The healthcare revenue cycle information needs to be accurate and timely, and it all starts with information capture during registration.

Let's look at two recent examples of major storms:

Baton Rouge

As was widely reported in the news, the floods in and around this Louisiana city involved both property damage and deaths. As of Aug. 25, FEMA had approved more than $205 million in relief for Louisiana residents, with the majority of this money going to "temporary rental assistance, essential home repairs, and other disaster-related needs."

Not surprisingly, FEMA encouraged affected residents to reach out to insurance professionals quickly, getting in touch with an adjuster within 48 hours and submitting the Proof of Loss statement within 60 days.

For insurance professionals, both of these deadlines point to the need for a well-tailored system, and gathering as much information as possible at the beginning is a huge asset. The site also cautioned possible claimants to take pictures and make lists, which could implicitly depend upon the insurance company's ability to process them digitally.

"PROMEDICAL can capture missing information for a work related or auto accident claim using innovative tools that may not be available to our client's registration team."

Fortune measured the money devoted to this storm against some of the other FEMA-aided instances in its history. The organization spent $170 million in August for floods in Louisiana alone.

Florida

The big news for the Sunshine State came earlier this month, when the Category 1-strength Hurricane Hermine passed over Florida, the first storm of its kind to do so since 2005. On Sept. 13, Governor Rick Scott addressed another storm system in a press release, known then as Invest93L.

"Just earlier today this storm had a zero percent chance of development," Gov. Scott said. "Now, after rapidly intensifying over the past few hours, the storm has a 40 percent chance of development and Floridians must prepare for the possibility of a tropical depression or storm impacting Northeastern Florida." By the next day, it had progressed to Tropical Storm Julia.

Karen Clark & Co. estimated the financial losses from Hermine to equal around $500 million, with more than 50,000 claims involved, according to Carrier Management. Peak sustained winds were estimated at 80 mph.

Unfortunately, many people were injured in work-related activities and auto accidents during these storm events of 2016 and required a hospital visit as a result.

What PROMEDICAL can do

Healthcare financial professionals have to work hard to gather as much information as they can relating to a claim. PROMEDICAL can help capture missing information by using our innovative technology tools.

In addition, we give patients easier ways to access important web based solutions, with multiple language offerings and an online portal. Our patient forms are also easy to access from our main site. Learn more about outsourcing services during a disaster by contacting us today.