As organizations continue to struggle with reduced top and bottom lines, they are increasingly focused on maintaining revenue integrity. That means optimizing processes and workflows in each of the three major revenue cycle streams – upstream (patient engagement), midstream (revenue recognition) and backstream (billing and collection). Fortunately, if you are an Epic user, you have tools in each of the three streams to help improve your revenue integrity accuracy, efficiency and productivity.
Hayes' Healthcare Blog
The healthcare industry continues to be in flux. The defeat of the Republican’s plan to repeal and replace the Affordable Care Act ensures that the status quo will continue. However, that status quo means a continuation of revenue reduction and pressure on margins. Meanwhile, the implementation of MACRA, the march to value-based care and a shift to alternative payment methods goes on.
All these factors ensure that revenue cycle optimization is more important than ever and organizations will continue to focus on plugging leaks, streamlining processes and implementing automations. Some of the biggest challenges include billing and collections errors, lack of claims process monitoring and insufficient staff training.
Epic’s end-to-end solution continues to attract new clients and is one of the fastest growing EHR applications in the industry. The comprehensive nature of the Epic solution makes it an attractive option, but the breadth of the platform makes it more critical that you ensure it is integrated properly in your organization. There are dozens of modules in the Epic offering, and they can sometimes be isolated in separate siloes. Without an effective integration plan, you may not see the results you need.
Focusing on these four key areas will help ensure you get the full benefits of your Epic solution.
The turmoil in the healthcare industry is no more apparent than the effect it is having on patient health insurance. Rising costs in premiums and deductibles, the establishment of healthcare exchanges under the Affordable Care Act (ACA) and a workforce that continually changes jobs is forcing mass confusion in the healthcare insurance market.
As people assume more responsibility for payments, they are shopping for less expensive insurance options. To accommodate this new consumer mentality, insurance companies are offering a wider variety of plans than ever before. These dynamics place even more stress on the already overburdened front office function of most providers.
With patients moving from plan to plan, verifying eligibility has become crucial for hospitals and physician practices. The complexity of plan options makes the process even more challenging for front office staff. Determining coverage, benefits, co-pays and deductibles for each patient can be an overwhelming task.
Despite widespread use of electronic business transactions, many providers are still handling eligibility verifications manually. A recent report from CAQH Explorations reveals that health plans fielded more than 72 million phone calls on eligibility in 2015. The same report says the cost of a manual verification process is $8.39 per transaction, more than 17 times greater than the $0.49 cost of an electronic verification. In all, CAQH estimates the healthcare industry can save over $5 billion by using an electronic eligibility verification process.