How the System Broke Down
We need not look far to see how the surge in healthcare
spending—which rose approximately $933.5 billion between
1996 and 2013—directly correlates with a steady rise in prices
for healthcare services. 4
The problem is that many patients aren’t used to paying
large out-of-pocket sums for services such as elective surgery.
Instead, they’re frequently shocked at their medical bills or
reluctant to pay them. Simultaneously, we haven’t adjusted
to the fact that so many of our dollars come from the patient.
Because providers aren’t accustomed to financing (the way
hospitals are), the vicious cycle continues.
There are, however, opportunities to reverse this cycle—
although practices aren’t taking advantage of them. For
example, a lot of groups still rely on basic mail or phone calls
to reach patients, but there’s no tracking and reporting on the
hours involved in these efforts, which have a high failure rate.
By leveraging workforce automation and data analytics
tools, you can get in front of problems in the revenue cycle,
such as high rates of nonpayment for specific procedures.
In doing so, you can ultimately reduce bad debt.
While administrative staff work hard, they’re typically not
trained to work the type of receivable that’s coming to them
when the patient is responsible for a large portion of a healthcare bill. In some cases, a different personality type may be
necessary for a staff member who is discussing financial
issues with patients versus someone who is dealing with
Redesign RCM Workflows
Given these challenges, most medical groups would benefit
from a complete redesign of their RCM systems and processes. While the idea of a redesign might sound complex
and time consuming, it’s really centered around taking a new
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Never Redesign your RCM for patient- payment trends