Key Strategies to Better Manage Your Self-Pay Accounts
The pandemic increased the number of patients facilities are seeing and this also lead to the increase in the use of self-pay accounts. Your facility may not have been prepared for this sudden increase. Continue reading below to learn some key strategies to better manage your self-pay accounts.nnA study published late last year by the Urban Institute forecasted that over 10 million families would lose their employer-sponsored health insurance during the novel coronavirus (COVID-19) pandemic. As a result, healthcare organizations have observed a growing number of uninsured patients and a rise in out-of-pocket responsibility.nnOn the latest episode of The Revenue Integrity Show: A NAHRI Podcast, NAHRI Director Jaclyn Fitzgerald, CHRI, was joined by Juli Forde, director of strategic partnerships, AR optimization, ZOLL Data Systems in Broomfield, Colorado, for a wide-ranging discussion on how healthcare organizations should approach the new reality of escalating self-pay patient responsibility.nnForde offered several strategies to help organizations maximize reimbursement in these times. The first step, she said, is to ensure empathy and understanding toward the patient. “I think one of the things we do really well is we get a great H&P (history and physical examination) clinically for patients before we move into a treatment plan,” Forde said. “We make sure we really understand them. We need to be doing the same thing financially. So, a wonderful best practice is to obtain one of the solutions available that will partner with you and give you the financial information around the patient. That allows you to come alongside them in a way where they feel heard and they feel understood.”nnOrganizations can obtain a financial profile of an individual without asking invasive questions that make the patient uncomfortable, Forde said. One of the keys is for organizations to harness the new technologies that are available that help organizations understand the patient as a financial individual in addition to knowing them clinically.nn“If you’re still doing revenue cycle the way you did it five years ago, 10 years ago, there’s wonderful technology that you’re missing out on that really helps you deal with this profoundly difficult reality of a greater patient responsibility, a higher denial rate from the payers, an additional regulatory burden being placed on healthcare,” Forde said. “There are tools available that really make those lifts a lot easier and help you to maximize your reimbursement while giving the patients a wonderful experience.”nnIn addition, Forde stressed the importance of charity care. She said healthcare providers must put in place policies based on objective criteria to establish a successful charity care program, which should benefit both the patient and the organization. When organizations ask patients for the amount that they can truly afford based on their own financial characteristics, they see the average patient collection increase significantly, according to Forde. “So it’s very interesting that by appropriately and compassionately discounting the final charge within a compliant charitable discounting program, we actually recoup more of the patient’s self-pay responsibility,” she said.nnTo listen to the full podcast episode, search Revenue Integrity Show on iTunes, SoundCloud, Spotify, or Google Play. The episode is also available to stream on the NAHRI website.nnOriginal article published on nahri.org
The current Public Health Emergency has changed the way CMS has implemented new programs, such as MIPS and APM, and the timeline in which they will be incorporated. As MIPS & APMs continue to move forward, it is important to stay up-to-date about the newest changes in CMS policy and the way these new programs are being introduced. Continue reading below to find out more! nnAmong so many other timelines that were interrupted during our current Public Health Emergency (PHE), Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), also was thrown in a tailspin. Despite the challenges that have presented over the past year, the business of medicine must continue moving forward.nnDuring the PHE, the Centers for Medicare and Medicaid Services (CMS) has delayed the implementation of MIPS Value Pathways (MVPs) until no earlier than 2022. However, the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM) have been finalized for performance year 2021.nnThese elements of the Quality Payment Program (QPP) have also had some added flexibility by CMS during the PHE to encourage greater participation to Medicare Part B providers while removing some of the risk of a negative payment adjustment. As we begin the last month of the first quarter in 2021, it is important to mark March 31st on your calendar as this is the first of three APM participation snapshot dates for 2021. This is then followed by the April 1st opening of registration for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys as part of your MIPS participation.nnThis is not the year to sit back when it comes to your QPP participation. According to MACRA, CMS is required to have the QPP program fully incorporated by 2022.nn n
There are 5 emerging trends in value-based care for 2021. The practice of value-based care has picked up momentum because of the pandemic and pressure has been put on healthcare providers to stay up-to-date with trends. Continue reading below to learn more about the 5 emerging trends in value-based care this year.nnThe pace and pressure to embrace value-based care are picking up. The COVID-19 pandemic exposed the risks and limitations of reliance on fee-for-service reimbursement and, combined with the groundbreaking changes in health care delivery models and regulatory flexibility, indicate a renewed focus on value-based care. This article outlines five of the top trends to watch for in value-based care for 2021.nn1. Leaning Into Value-Based CarenOne of the lessons from 2020 is that reliance on fee-for-service can leave providers vulnerable to volatility and changes in demand. As utilization plummeted during the COVID-19 pandemic, providers who had invested heavily in value-based care have been better able to weather the pandemic and the economic downturn by having a consistent source of revenue despite low utilization. The rapid changes in health care driven by the pandemic only further emphasized the need for providers to lean into value-based care. Beyond the allure of steady revenue streams, new regulatory flexibilities and care delivery innovation creates an opportunity for providers to realize a more rapid rate of return on their investment in value-based care by increasing the portion of their business with value-based care reimbursement.nn2. Continued Innovation and DisruptionnWhile value-based care has always been an area ripe for innovation, 2021 presents a unique set of circumstances that point to a surge of innovation and disruption in both payment and care delivery models. Value-based care had been a priority for the Centers for Medicare and Medicaid Services (“CMS”) under the Trump administration, but there is no reason to expect a change of course away from value-based care. In fact, the Biden administration’s health care goals will likely require an increased emphasis on cost savings, which may result in an even greater push towards value-based care. Some news outlets are reporting that Elizabeth Fowler is a front-runner to lead the Center for Medicare and Medicaid Innovation, further signaling that CMS’s momentum on value-based care will continue. Commercial payors also continue to push towards innovative payment and care models as COVID-19 has highlighted the inequities in the healthcare delivery system and challenges for providers.nn3. Capitalizing on COVID-19 InfrastructurenThe COVID-19 pandemic prompted transformational changes to the health care system that portend continued opportunities to manage patient care and provide quality care in lower cost settings. As a result of the pandemic, both the federal and state governments threw open the doors to allow providers to furnish services via telemedicine and other digital health modalities during the COVID-19 public health emergency. Many of the telehealth waivers have been made permanent. Providers who have embraced digital health as a way to weather the pandemic will also have the opportunity to capitalize on this investment as a way to manage patient care and see a return on investment for services that are typically not reimbursable under fee-for-service arrangements. CMS also created the Hospital Without Walls and Acute Hospital Care at Home programs to increase hospital capacity during the pandemic. Commercial payors have been eager to seize on these opportunities to promote lower-cost services. Providers who have invested in these types of programs similarly provide an opportunity to provide quality care in lower cost environments, which will benefit providers who are fully engaged in value-based care.nn4. New Opportunities for Provider AlignmentnRecent changes to federal law aim to lower barriers to value-based care. In particular, CMS and the Office of Inspector General (“OIG”) created new flexibility under the Stark law and Anti-kickback Statute for value-based arrangements to allow providers to enter into value-based care arrangements that previously may have been prohibited. While the new exceptions and safe harbors still require that arrangements be carefully crafted, they provide new opportunities to align with providers and to incentivize activities that promote value-based goals that were previously unavailable. Additionally, the sweeping interoperability and information blocking rules aim to ensure that patients and providers are able to access health information, further reducing structural barriers to value-based care.nn5. Emphasis on Social Determinants of HealthnFinally, players in the value-based care space—particularly in Medicaid managed care programs—are placing greater emphasis on addressing social determinants of health. Providers and payors are beginning to recognize the crucial role that non-medical factors play in patient health. By solving for these issues—such as transportation, food, housing, language services, etc.—providers and payors are able to realize significant benefits in improving patient health and outcomes while keeping medical costs relatively low. The focus on social determinants of health is an emerging trend in value-based care that is likely to grow as players seek creative ways to manage patient care through value-based arrangements.nnAs providers and payors emerge from the upheaval of the pandemic and the resulting revolutionary changes in health care, we can expect renewed interest in value-based care. Opportunities abound to capitalize on the changes wrought by the pandemic, as well as emerging prospects, by fully investing in value-based care.nnOriginal 
Making the most out of the time we have at work to stay healthy can be a real struggle. Health and workplace environments can alter the way we feel so finding this balance is essential to feeling your best. Continue reading to learn more about workplace health and how to stay active.nnHeart health is essential and should be part of your daily routine both at home and at work. As part of Heart Health Month, this little reminder from the American Heart Association can be printed or saved as your reminder to not let your workload distract you from a healthy life.nnFollow these five exercises as a way to break up your day.nn
MGMA CFO analyzes the financial impact of COVID-19 on physician practices and outlines some long-term strategies that healthcare organizations should implement as a precaution in case another pandemic occurs. These strategies may help avoid the negative financial impact we saw with COVID-19. Continue reading below to learn more!nnThe path forward to a more financially sustainable operation and prosperous future remains tenuous for most medical groups but there are opportunities for leaders who are willing to make the necessary changes.nnWhile hospitals and health systems suffered historic financial challenges related to the COVID-19 pandemic in 2020, medical groups and physician practices were not spared either. These smaller provider organizations endured similar constraints due to declining revenues and rising expenses, a trend that hasn’t ceased thus far in 2021.nnThe path forward to a more financially sustainable operation and prosperous future remains tenuous for most medical groups but there are opportunities for leaders who are willing to make the necessary changes. Akash Madiah, CFO of MGMA, outlines the long-term strategies that medical group executives should follow to be more resilient and less vulnerable if another pandemic or industry-changing calamity occurs.nnThis transcript has been edited for clarity and brevity.nnHealthLeaders: What is your advice for financial executives at provider organizations as they continue to deal with the difficult dynamics caused by COVID-19? Are you optimistic or pessimistic about their prospects? Why or why not?nnMadiah: First, I’d advise that everyone take advantage of the federal financial assistance programs, namely the [CARES Act] Provider Relief Fund, which has now been reopened, and the Paycheck Protection Program. Our government affairs team based in [Washington, D.C.] has done remarkable work advocating for [physician] practices and organizations to receive relief through the pandemic. MGMA members have been involved and active in the advocacy efforts. In one of our grassroots campaigns, we mobilized 2,000 medical practices to send over 7,000 letters to Congress in less than 48 hours and it helped secure sufficient funding for medical practices.nnIn the relief packages, there’s over $175 billion allocated for healthcare providers, so there is available money out there. These programs were put in place to help medical practices and businesses stay afloat and overcome the downside impact of the pandemic. With respect to these programs, they’re loans but there’s an administrative aspect to these. I think with calendar year 2021, there’s going to be a lot of backend work for the medical group community to make sure that the loans and grants are forgiven. That’s the burden for the healthcare community at large, but overall, I’m pretty optimistic about where things are going.nnThe spring and summer of 2020 were the worst of times and the darkest period. We’ve had an uptick since as people feel more comfortable going back to doctor’s offices. [With] people who skipped out on their annual checkups, those dollars aren’t ever coming back, but that’s where those relief programs were meant to help. There is a backlog of elective procedures; I think the trend is going up, and I feel that’s going to continue through the rest of the year, especially with the vaccine rollout.nnHL: What role should the federal or state governments play in assisting these care providers that are facing a dual-threat to their bottom line? Additionally, is there any action that the payer community should take to help their struggling counterparts on the provider side?nnMadiah: As I mentioned, the money is out there, so it’s up to providers to access that. I think the government has responded and everybody should be accessing the dollars based on their eligibility. But now going forward, I think the biggest thing government can do is ease the administrative burden to make sure that reconciliation and forgiveness of loans is easy for the medical groups.nnNeedless to say, medical groups are going to be busy enough this year, and focusing on patient care should be paramount and not bogged down by the administrative burden. I’ll also add that our CEO Dr. Halee Fischer-Wright sent a letter to the Biden administration [earlier this month] asking that medical group practices are included in the vaccine distribution strategy given their role as community providers across the country.nnThe payers are a little trickier, they are under no obligation to help, but I would say any cooperation and long-term view can help since we’re all in this together. [Payers] have a role in supporting the mechanisms that keep both patients and medical practices healthy in 2021, specifically making sure things that helped providers through the pandemic, like reimbursements for expanded telehealth services, continue. Then, like the government, any reduction to the administrative burden, such as relaxed prior authorization, can only help going forward.nnHL: Are you fearful about the continued effort by private equity firms to acquire medical groups or physician practices? What impact do you think that behavior will have on the healthcare industry at large?nnMadiah: When private equity enters an industry, there’s a general sense that they will cut costs, slash-and-burn, and then sell it for a profit. I think that’s probably the most pessimistic view of them. I’m not fearful of them; they’re a player in all industries across America and they can cut costs in a good way and try to create synergies to make sure revenues are increasing. When it comes to healthcare, there’s a fear [that private equity] is going to hurt the patient and decrease access to healthcare. The profit tone that comes along with private equity often takes away from the altruistic tone that we convey with our members at MGMA. That’s the push and pull with private equity.nnThe big question is how will [private equity] generate the returns they’re used to seeing while also improving the patient experience, which again means more access and better outcomes. If they’re willing to invest in technology and processes that can help the industry, there can be an upside. But that comes at a time horizon that’s a little bit longer than they’re typically used to because while healthcare is continually changing, the speed of that change is not always conducive to what private equity is traditionally invested in. With our members there’s general skepticism with what approach [private equity] is going to take; are they going to be investing for the long-haul or are they taking the short-term view and motivated by profits?nnHL: What are the critical long-term strategies that medical group executives should follow to be more resilient and avoid being vulnerable if another pandemic or industry-changing calamity occurs?nnMadiah: The biggest thing is always to be vigilant. On the expense side, make sure there’s no extra waste in your practice and [don’t] worry about cutting things when the money is tight. The other part of that is being on the offensive, to the extent you have the resources to do so. Invest in your organization to make it more efficient or profitable now rather than being reactive in an urgent situation in the future.nnOne example from the pandemic is telehealth. That was a huge lifeline to a lot of practices to make sure revenue was still streaming in, but many practices had not implemented telehealth prior to COVID-19 and they were being more reactive. We’re trying to invest more in data now to make sure we’re looking ahead and being prepared for the future.nn[Referencing] the MGMA year-in-review report, a lot of practices are changing the way they measure their key metrics of success and looking at things on a more frequent basis rather than a monthly basis.nnThis doesn’t just go for healthcare, but reassess space needs. Understand how successful you are as a remote organization and what you should be investing in going forward. That applies to a number of industries across America, but the bottom line is to be proactive, try to foresee what challenges you need to get ahead of, and make sure to invest in those areas to the extent that you can.nnEditor’s note: This conversation is a transcript from an episode of the HealthLeaders Finance Podcast. 