5 Value-Based Care RCM Survival Strategies

By Ann Bilyew, CEO, MDeverywhere

With the imminent arrival of value-based reimbursement, the days of billing inefficiencies are officially history. But where can practices find more opportunities for savings? Operating margins are already razor thin and many physicians are taking reductions in salary just to keep their practices open. As it happens, most practices leave up to 30 percent of their potential revenue on the table every year according to statistics from the Medical Group Management Association – and much of it can be recouped.

Here are the five essential survival skills and tools that practices can pair together for financial viability in the new healthcare landscape.

1. Keep A Full And Productive Schedule
   Few industries make it so difficult for their customers to access services, whether it’s repeatedly putting would-be patients on hold or routing them straight to voice mail. Once connected with a live person, it takes as long or longer to settle on an appointment time. Patients hate this process. So do staff. It should have been changed long ago.
   Survival Toolkit: 24/7 Online Patient Scheduling And Automated Provider Follow-up
   Leveraging today’s technology, patients can schedule their own appointments online at a date and time they prefer. This in turn allows practices to capture patient contact info for sending automated appointment and follow-up reminders. An online scheduler also drives patients to a practice’s websites, where they can learn about services offered, credentials and more about the value their providers offer.
2. Collect The Patient’s Responsibility Of The Service
   With patient responsibility now at close to 25 percent of the total value of the bill, practices need to develop core competencies in collecting co-pays, co-insurance and deductibles at the point of service. To do so, the practice must have information on patient responsibility and past due amounts close at hand.
   Survival Toolkit: Automated Patient Eligibility And Patient-friendly Price Estimates
   Payor denials frequently arise from patient ineligibility for services, but traditional verification processes are cumbersome and often ineffective. By contrast, automated patient eligibility verification will quickly drive increased and early collection of patient responsibility. Software patient pricing tools that communicate, clearly, the patient’s portion, will also facilitate payment from patients who understand their bill, including terms and timing.
3. Eliminate Denials
   Prevention is the first and most important round of defense in effective denials management. A high clean claim rate should be a continuous objective.
   Survival Toolkit: Automated Claims/Scrubber Rules Engine That Works Concurrently With Charge Entry
   There are two primary reasons a claim doesn’t result in a payment: either the payor didn’t receive it, or deemed it defective due to wrong or missing data. This is where an automated claims editing solution comes in handy by flagging problem areas before the claim goes out, giving practices the opportunity to correct it pre-submittal.
4. Enforce Your Payor Contracts
   Increasing the number of clean claims that get out the door decreases the inflow of denials, but doesn’t eliminate payor errors in payment---which are usually to the payor’s benefit. Compounding this are all the countless plans to keep up with and their applicable state requirements. Another big problem: underpayments are spread across hundreds of patient records, which means the amount per patient is small and easily overlooked. But they add up to substantial lost revenue—as much as 11 percent each year.
   Survival Toolkit: Partner Expertise And A “Knowledge Repository”
   Monitoring and appealing expected payments doesn’t have to be overly complicated or expensive if you have the right resource or partner working on your behalf. The revenue generated from the underpayments will more than cover the cost and result in a significant gain overall. The right technology system will allow your practice to create a knowledge repository on fee schedules and reimbursement rules for your key payors, and create system flags and alerts to identify underpayments for every line item. It can even assist in creating individual and bulk appeals.
5. Thrive Through Proactive Training And Tools. As healthcare continues to undergo major transitions, especially to value-based care and ICD-10, the wise practice won’t underestimate the degree of change on the way. Doctors won’t be able to learn about new laws and regulations on the fly. AR and billing personnel will need to understand the new coding schema. Proactive training is key—but here again, where should practices start? The best option for many is to engage with a revenue cycle partner that has already made the investment in the tools, systems and training for these major evolutions in healthcare (and the many more to come). Survival will be more likely than working alone.

About The Author
Ann Bilyew served as a Board member to MDeverywhere for five years and joined the company full-time as its Chief Executive Officer in 2006. Bilyew has 20 years of venture capital and health care operations experience. Before joining MDeverywhere, she served as partner of Advent International. Bilyew has led or managed Advent’s investments in companies including Health Hero Network Inc., Impliant Ltd., MDeverywhere Inc., Med e-Manager Corp., MedVantx and Millimed Holdings Inc. Prior, she was a managing director at Health Business Partners, a boutique investment bank and venture capital fund. Bilyew received a BS degree, with highest distinction, from the University of Kansas and a Masters of Business Administration from Harvard Business School.