Maximize Your Potential by Minimizing Revenue Loss

 

A new year means the opportunity to start with a clean slate. It’s a time to assess growth goals and the workflows that will help you achieve those goals amidst regulatory, consumer and competitive expectation. Reimbursement is repeatedly listed as a top challenge for all providers – from the largest health systems to the most rural practices.

 

A recent study shows that the average outpatient visit costs nearly $500, and the average inpatient stay in the US was over $22,000.[1] Combined with more payment responsibility on the patients’ shoulders and a deeply complex and varied insurance climate, it’s no surprise that three to five percent of net patient revenue is underpaid.

 

The ultimate root causes for these underpayments are varied and span end-to-end in the revenue cycle, resulting in denials, aged receivables or ultimately contractual underpayments. Resource constraints, both technology and labor capacity, can often make these underpayments difficult to identify let alone recover.

 

In 2019, healthcare costs are expected to rise by about 6 percent. Trends such as healthcare industry's consolidation has stymied further progress in lowering costs, says FierceHealthcare.[2] At the same time, consumers are demanding more convenient access to care, and the focus on new sites of care—such as retail clinics and virtual visits—are also increasing costs as utilization rates increase.

 

As we head into the new year, increase your potential by securing your financial workflow. Consider the following strategies to maximize your practice’s potential by minimizing revenue loss:

  • Look for the root causes for underpayments. According to the American Hospital Association, combined underpayments for Medicare and Medicaid in 2017 were $76.8 billion, an increase from the $68.8 billion shortfall in 2016.[3] Understanding the foundational issues can help with both short- and long-term financial strategy.

  • When looking at underpayments, don’t silo your efforts to one area. Underpayments vary widely and can compound, so use a comprehensive approach to address the full recovery opportunity. In 2017, a review by the Advisory Board showed that revenue cycle performance has lagged across key areas, now costing more just to achieve flat performance. Cost focus across the healthcare industry shows that the average 350-bed hospital misses $22 million in revenue capture opportunities.[4]

  • Assess the technology you’re using to identify underpayments across the revenue cycle. Make sure you’re deploying the right solutions and leveraging the right subject matter experts.

[1] https://revcycleintelligence.com/news/average-healthcare-costs-for-outpatient-visit-nears-500

[2] https://www.fiercehealthcare.com/finance/pwc-healthcare-cost-trend-consolidation-mergers-convenience-care

[3] https://www.healthcarefinancenews.com/news/medicare-medicaid-underpaid-us-hospitals-768-billion-2017-american-hospital-association-says 

[4] https://www.healthcarefinancenews.com/news/average-hospital-revenue-cycles-losing-roughly-22-million-missed-revenue-capture-thanks-cost

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