Are Your Accounts Receivables Going in the Wrong Direction?

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A recent MGMA poll, asking “How have your days in A/R changed in 2021?”, found that 49% of respondents said their time in A/R has increased in 2021. Thirty-seven percent (37%) said they stayed the same, but is that good? Only 15% said that it had decreased.

It is well known that the longer a debt goes unpaid, the harder it is to collect.  A study from Debt.com found that 50% of Americans have medical debt, increasing from 46% in 2020. They also found that more than half of that, 57%, owe at least $1,000, if not more, due to diagnostic tests, emergency room visits, or hospitalizations. In all, debt collectors hold approximately $140 billion in medical debt, not including credit cards and medical debt that hasn’t been reported to consumers’ credit reports yet.

The Good and the Bad

A number of the respondents shared some of the challenges and successes concerning their revenue cycle. For those practices whose A/R aging improved, the following are some of the reasons provided:

  • New billing rules were implemented that increased the number of clean claims being sent out.
  • Renewed enrollment in ACA marketplace plans reduced the number of uninsured patients, making collecting balances easier.
  • Outsourcing all or portions of their revenue cycle management or utilizing new AI or machine learning tools to lessen repetitive tasks.

As for those practices that stated their A/R had increased:

  • Lack of office staff to work outstanding balances or large learning curves for new employees.
  • Some declared that they felt that payers played a role by issuing questionable medical claim denials and delays in reviewing appeals.
  • Whereas prior authorizations were called out as an issue for several of the practices.

There are a couple of ways you can start collecting on these outstanding balances:

  • Set up payment plans for those who can’t pay off large balances.
  • Require the payment of copays, deductibles, or outstanding balances before providing services.
  • Require down payments for expensive procedures like surgeries.

Your revenue cycle management is what keeps your practice doors open.  Part of that management is ensuring that your A/R is under control, with no more than approximately 14% of your aging over 90 days. If your revenue cycle management team is on top of things, then claims are going out clean, passing the clearinghouse the first time and denials are being appealed immediately.  They are managing to obtain eligibility before a patient’s visit so they can collect copays, deductibles, or amounts owed upfront. If not, then there is an issue that needs to be addressed.

Medical Staffing Shortage

One of the biggest issues the healthcare industry is facing right now is a shortage of staff, putting existing employees under intense pressure to do more and more administrative work – taking the focus off quality care for your patients. Another poll by MGMA showed that 42% of respondents stated that recruiting was their number one issue. Thirty percent stated that revenue was their top concern, but how can you increase your revenue if you don’t have the right people in place for your revenue cycle?

Outsourcing RCM Can Help

A way to help eliminate this issue is to outsource your revenue cycle management, allowing them to do what they do best while you and your staff focus on your patients. By outsourcing, you put an entire team of professional billers, coders, and A/R experts to work for you without the added expense of salary, training, or staff turnover.

At Billed Right we partner with you to ensure that your revenue cycle runs efficiently and effectively. With a team of AAPC certified coders and experienced billers, we are with you every step of the way. An additional benefit of outsourcing with us is that we provide reports weekly, monthly, quarterly, and annually so you know exactly what is happening and can keep track of your practice’s financial health.

We see our role as a strategic partner, not just a vendor, and work to optimize your entire revenue cycle to help you grow your practice!

To learn more about how you can partner with Billed Right for your prior authorizations please contact us today!

Price Transparency in Healthcare – What Does it Mean?

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Until now, costs for healthcare were anything but transparent. A majority of people receive medical services without a clear understanding of what the charges will be, how much their insurance company will cover, and that prices can be vastly different from hospital to hospital.  However, this situation is changing. New rules from CMS, which are rolling out over the next few years, are targeted to provide more healthcare price transparency to provide patients more insight and support competition within the healthcare industry.

How will greater price transparency impact you? The following summarizes what the changes will be and how they could impact patients, providers, and insurance companies:

  • January 2021 – Hospitals were required to post rates negotiated with insurance companies, as well as a patient-friendly list of 300 “shoppable” services, such as hip replacement and tonsillectomies, consumers can shop from.
  • January 2022 – Insurance plan data files showing in-network provider rates, out-of-network coverage rates, and in-network prescription rates must be made available.
  • January 2023 – An online shopping tool for patients for 500 “shoppable” services including 70 specific services mandated by the government. The tool must include an out-of-pocket cost estimate along with negotiated pricing.
  • January 2024 – The pricing tool created in 2023 must now include all remaining procedures, drugs, and durable medical equipment.

The federal government is hoping that this series of requirements will encourage new thinking in the way of medical billing and the patient experience, as well as provide patients with additional access to pricing information.  The medical industry is now provided with the opportunity to put in place tools that will make it easier for patients to understand and predict medical expenses.

Benefit for the Patient

The driver behind healthcare price transparency is to help patients better understand the cost of medical services and as one way to eliminate large surprise medical bills. By utilizing these new public databases, a patient can compare the costs of hundreds of non-emergency services to determine whether they might be able to save money by opting for another medical provider or facility. These tools and information will allow for better planning of medical expenses, lessening the chance of being surprised with a bill they are not able to pay.

Keep in mind, all of this has limits. A patient needing emergency care is not going to comparison shop before heading to the emergency room. There are some clear-cut cost comparisons like MRIs or medication, however, sometimes it is impossible to foresee all the costs for a surgery, for example. Still, the hope is that offering insight into some medical pricing will promote competition and dissuade price gouging.

Although everything won’t happen overnight, hospitals have been responding to these changes in a few different ways. There are those working to just be compliant. Then there are those who will utilize this opportunity to be more than just compliant, by completely retooling the patient billing experience. The hope is that by offering transparency, patients can plan better for non-emergency services, be more comfortable before scheduling a procedure, and not be presented with a surprise bill they were not ready for after the procedure is completed.  Offering them the ability to truly prepare can mean the opportunity to work out a payment plan, financing options or to postpone the procedure if they are unable to afford it at that time.

Insured vs Uninsured

While price transparency does not completely solve the issue of affordability, it will give uninsured patients information which will allow them to make plans for their procedures and maybe even provide some negotiating power. Power such as being able to negotiate a hospital down to the same rate that has been set with the insurance companies.

However, for the insured, it is a bit more complex as they have deductibles, copays, and out-of-pocket limits that figure into their scenario. It will all depend on their specific insurance plan as to what their final bill will be.

Will the Patient Experience Change?

The current and upcoming changes will have a direct impact on the average patient, as they will have access to pricing information not previously available.

The bigger change may be a bit more indirect. As this new regulation rolls out, consumer-friendly developments may emerge that could change the overall patient experience by allowing them to make decisions based on value, accessibility, convenience, quality, and safety.

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that can help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue. No matter what challenges physicians face, we never waiver from our goal to be a partner in strategy to promote practice growth.

 

Contact Billed Right to learn more.

EFT Fees – MGMA Pushes Back Against Predatory Business Practices

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Medical Group Management Association (MGMA) released findings from their Stat poll, conducted on August 10, 2021, regarding medical practices being forced to pay fees to receive EFT payments from payers. According to their research, 57% of respondents, when asked “Are insurers charging your practice fees you didn’t agree to when sending payments via EFT?”, responded “yes” and 43% said “no”.  For this same Stat poll a year ago only 26% said “yes” and 51% answered “no” and 23% were “unsure”. The data comparison year over year shows that this issue has doubled in just the last year.

For the most recent poll, of those who responded “yes”, 86% stated they were being charged anywhere from 2 – 3% of the total medical services payment by the payment vendor to receive EFT payments. In other words, they are having to “pay to get paid”. Obviously, the problem has grown since the Centers for Medicare & Medicaid Services (CMS) eliminated specific guidance in 2017 that prevented insurers and payment vendors from participating in these unfair business practices.

Part of the Affordable Care Act (ACA) of 2014 requires payers to offer medical practitioners the option of obtaining their payments through EFT. This idea was implemented to help streamline payment processes. However, payer partners have been more frequently telling providers that they must get payments through a specific vendor, which then imposes a seemingly inescapable administrative fee.

In light of this information, MGMA has written a letter to CMS asking them to utilize their authority to prohibit these EFT fees. They called on CMS to clearly restate prior industry guidance, which was removed in 2017 by the previous administration, or repost the previous guidance that was removed.  They also are of the opinion that if CMS will not present clear guidance, they should then provide the reason why they are not using their authority to stop these abuses.

MGMA stressed that they are not opposed to a vendor’s ability to offer services that have administrative fees.  Just that health plans should be clear in stating the details of the fees and practitioners should have an option instead of being forced to utilize the third-party service.

 

EFT Fees – Unfair and Counterproductive to Interoperability

As the EFT option was developed with the desire of stimulating cost savings, payers are hindering progress by taking a cut out of what they agree to reimburse medical providers. These fees are counter to the intent of the administrative simplification terms of the ACA and the law’s intent of decreasing administrative wastefulness and cost. In implementing the supporting ACA regulations, CMS ordered a standard EFT transaction and supporting operating rules which means that health plans are mandated to offer EFT reimbursement to practitioners.

The benefits and savings associated with the use of EFT are well established. Payers have saved millions of dollars providing payments via EFT as they do not have to print and mail a paper check. For medical providers, the most prevalent savings has been in the ability to automate the connecting of the electronic payment with the Electronic Remittance Advice (ERA), as well as the time saved by staff to manually process paper checks, allowing more time to be spent on patient care.

Moving forward MGMA will continue to put pressure on the federal government to take action to prohibit insurers and their payment vendors from imposing EFT fees on medical practices.

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that can help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue.

 

Contact Billed Right to learn more.