Revenue Cycle Myths: Realistic Ways to Increase Reimbursement in an Era of Value-Based Care

February 7, 2014 by Merideth Wilson

With the rapidly changing healthcare environment, many organizations are taking a hard look at their revenue cycle, seeking proactive ways to enhance both efficiency and performance in the era of value-based care. While the need to improve is clear, the opportunities for improvement may be obscured by myth and misperception. For example, consider the following long-standing myths about patient payment that, if not set straight, could limit your organization’s ability to optimize the revenue cycle and enhance financial performance.

MYTH #1:  All patients are equally likely to pay.

Reality: No two patients are alike, whether you’re looking at their medical conditions or their financial data. Assessing a patient’s likelihood to pay at the earliest point in the patient encounter can help you design your collections efforts to not only increase the probability of patient payment, but also foster greater patient satisfaction. By leveraging data and analytics to segment patients, you can realize a proactive and customized approach to collections that takes into consideration a patient’s unique financial situation and payment history, and tailors payment amounts and collections strategies accordingly.

MYTH #2:  It’s hard to have meaningful financial conversations on the front end.

Reality: Contrary to popular belief, most patients are receptive to a financial conversation with their healthcare provider. Patient access staff can serve as the gatekeepers of the patient experience, engaging patients even before their time of service with personalized and informed financial discussions about patient responsibility and payment options. With this unique patient data at their fingertips, staff can also assist patients who may have trouble meeting their financial obligations, checking eligibility for internal and external financial assistance programs and automating the enrollment process.

MYTH #3: It’s impossible to know what patients owe across a system in one look-up.

Reality: Organizations can once again turn to data and analytics, using it to aggregate prior balance information from across the healthcare system. This allows patient access staff to view comprehensive open balance data as part of the registration process and use scripts to guide compassionate financial conversations. Even if these fact-based discussions don’t lead to immediate payment, the additional reminder that a balance is due often prompts a patient to action, yielding faster payment.

Dispelling these and other myths is simple when an organization uses tools that leverage both clinical and financial information to increase reimbursement in an era of value-based care. These proactive efforts result in less risk, increased collections and enhanced patient satisfaction. That’s a reality that every healthcare organization should experience!

What myths are you debunking at your organization?