Forecast for Healthcare Finance 2015

“Cheers to a new year and another chance for us to get it right.”

– Oprah Winfrey

2015 is forecasted to be another year of tremendous change in healthcare.  Looking back at my long career, I realize that every year has been a year filled with change.  Often, adjusting to change requires greater mastery of the basics.

For example, let’s look at revenue and financial management.

• A recent Health Leaders Media article identified high-deductible health plans as the top revenue challenge in 2015:  It states: “Healthcare financial leaders say high-deductible health plans, whether pushed by employers or offered through health exchanges, are rapidly expanding the risk of non-payment.  Many consumers choose plans with the smallest upfront cost and largest deductibles…”
• One-third of American were enrolled in a health plan with a deductible of $1,000 or more in 2012 and 14% had a deductible of at least $2,000 in 2012 according to a Kaiser Family Foundation study.
• The Camden Group recently published “Top 10 Trends and Implications for Medical Groups in 2015”.  Trend #3 states “Patient Collections cannot be ignored…”
• An Aon Hewett analysis states employee premiums and out-of-pocket healthcare expenses doubled since 2009, will increase 8% from 2014 to 2015, and out-of-pocket costs will be $2487.

Yes, more self-pay can result in more financial risk, but this risk can be effectively managed by going back to the basics.

The following 9 questions are a solid starting-point:

1. Are our Review Financial Policies current and do they reflect the new payment paradigm?  Are we clear in our expectations on patient financial responsibility?  Do we ask for payment at the time of service and provide patients the opportunity to pay by cash, check, PayPal or credit card?
2. Is our technology current?  Are we prepared for ICD – 10?
3. Does our team provide a clear, consistent message on Patient Financial Responsibility?  Have we trained them adequately to collect at the time of service?
4. Do we verify insurance coverage and do we know who is financially responsible?  For example, do we know the patient’s financial responsibility (copays, deductibles, exclusions, etc.)?
5. Are we collecting the patient’s financial responsibility at the time of service?  If payment arrangements are needed, do we have a system for monthly payments?
6. Are bills accurate and timely?  Some experts recommend a 24 to 48 hour standard for charge posting, check posting, rejected claims, and responding to correspondence.  Daily submission of claims and monthly review of unpaid claims are also frequently recommended.
7. Are our coding practices current and acceptable?
8. Are payers reimbursing at our contracted rates?  Are our payer contracts acceptable?
9. Is our monthly review process meaningful and do we have goals?    Do we have the ability and are we routinely reviewing key numeric indicators?

I was impressed by the simplicity of a program that focused on only 4 numbers:

Yes, 2015 will be a year of changes and challenges.  As shown in the above, mastery of patient collections can yield major results.  Achieving these results is realistic with good systems, effective staff, and straight-forward goals.  In 2015, Physician Partners and the Physician Resource Center will continue to offer our members the advantages of a large medical group while respecting the autonomy of the individual practice.

We’re here to help!  Happy New Year!