The healthcare industry's shift toward lower reimbursement rates and increased patient responsibility threatens organizations' budgets and resources, according to Merideth Wilson, Experian Health's vice president of revenue cycle solutions.
Here are four ways to stave off the impacts of decreased reimbursement, as published in MedCity News.
1. Close gaps in payer contracts. Organizations should negotiate more favorable contract rates and hold payers accountable for the terms of their contracts. Use technology to monitor payer contracts rather than manually tracking fee schedules, modifiers and bundling edits for various payers.
2. Provide transparent price estimates. Transparent price estimates should be offered throughout the continuum of care for each patient. Organizations should take this action not only because nearly 30 states require this information to be shared, but also because helping patients become aware of their costs makes them better prepared to pay.
3. Submit clean claims. Denied claims result in delayed, lower or nonexistent payer reimbursement. Comply with Administrative Simplification standards and take advantage of training resources from the AMA, Healthcare Financial Management Association and the Healthcare Information and Management Systems Society to get denial rates as close to zero as possible.
4. Improve clinical documentation. Organizations can add millions of dollars to their bottom lines by concisely and accurately documenting each procedure with adequate proof it is medically necessary according to payer requirements. Involve employees from patient access, billing, managed care, coding and health information management teams to validate the medical need for every patient-facing action.