According to the 2016 Revenue Cycle Management Report, a survey of 2,000 independent physician practices and 200 hospital-based physician practices by Black Book Market Research, the profit margins of healthcare provider organizations continues to be negatively affected by traditional patient billing solutions.
To begin, many organizations are unprepared for value-driven care. The survey found that 9 in 10 practices are financially and technologically unprepared to provide value-based healthcare to their patients — which is a significant and increasing payment trend, especially among hospitals. What’s more, despite the added emphasis on compliance and risk management, many physicians characterized themselves as “not tech savvy,” adding that the investment in hardware, applications, and training is too expensive for many small practices.
Also, unsurprisingly, physicians want to spend more time with patients, while reducing their administrative burdens. 77 percent of physicians surveyed believe they need to find more direct patient care time that is currently occupied by administrative and business tasks for their revenue cycle management. Additionally, 97 percent of independent groups and solo practices experience high business staff turnover, with changes in a provider’s billing department being especially damaging.
Practice Optimization Begins With Effective Charge Capture
The Black Book Market Research data underscores the need for healthcare provider organizations to ensure that their physicians capture charges effectively. Physicians accurately capturing the charges stemming from their own treatment of patients results in higher billing. Charge capture data also provides additional insight into the overall productivity of a practice and, therefore, the organization as a whole.
If optimizing the revenue generated by each physician wasn’t ample incentive, healthcare provider organizations are now facing greater scrutiny from no less than the Centers for Medicare & Medicaid Services (CMS). The agency has recently established the Targeted Probe and Educate (TPE) program — an audit that looks for “questionable billing practices” by Medicare providers. Those incapable of documenting bills submitted to the federal government face a range of potential actions, including exclusion from Medicare and the threat of criminal charges.
“Even if a physician practice or a larger medical enterprise were somehow comfortable leaving money on the table, the increased scrutiny of coding practices, as well as the benefits of valuable physician performance data to manage your practice, means that effective charge capture is no longer an optional sport,” said Steven Liu, MD, SFHM, founder and Chief Medical Officer of Ingenious Med. “For many healthcare provider organizations, that means finally getting serious about establishing a comprehensive and consistent process for capturing the necessary data.”
What Success Looks Like — in Real Dollars
Ingenious Med has enabled a diversity of healthcare provider organizations to optimize their practices, often by replacing their legacy paper charge capture workflow with an easy to use electronic option and providing visibility into physician activity through its reporting functionality.
In addition to optimizing an organization’s practices, Ingenious Med’s mobile technology enables physicians to capture charges at the point of care using their smart phones or tablets.
“By virtue of Ingenious Med’s streamlined census management and charge capture workflow, as well as our user-friendly technology, we never fail to see a significant uptick in an organization’s per physician profitability and revenue cycle acceleration,” said Liu. “As a result, team members on the clinical and revenue cycle side are freed up to focus on patient care and more meaningful activities.”
What is Your Organization’s Lost Revenue?
Based on more than 30 retrospective studies, Ingenious Med clients see an average increase in annual net revenue of $30,000 per full-time physician with charge capture capabilities alone, including a more than 7 percent increase in the number of captured charges and a 3.5 percent increase in gross dollars per charge.
However, because each healthcare provider organization is different, Ingenious Med has developed a Revenue Optimization Calculator (coming soon) that estimates the potential increase in revenue for practices based on numerous inputs, including the number of physicians rounding at hospitals, the average number of charges in a group, and the average dollars collected per charge.
As a result of these inputs — and based on the average results of analogous practices that are Ingenious Med clients — an organization will receive a detailed performance improvement analysis that includes:
- Potential annual number of charges.
- Potential average dollars collected per charge.
- Potential annual revenue collected.
- Potential annual revenue increase.
“The Revenue Optimization Calculator is the healthcare equivalent of ‘15 minutes could save you 15 percent or more on car insurance’ — only on steroids … For some organizations, we’re talking $15 million in recoverable revenue,” said Liu. “After all, the monies gained by even a small physician group dwarfs that of an auto policy and our calculator requires significantly less time to complete.
“Why would any revenue cycle manager not want to calculate his or her potential uplift?”
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