A hospital stay of any length can be extremely stressful for both patients and their family members. This vulnerable and emotionally gut-wrenching time can be complicated by confusion regarding billing. At a time when healthcare faces increasingly complex government regulations, outsourcing revenue cycle management to an expert team can maintain quality control and increase patient satisfaction.

The destabilizing effect of illness is magnified for low-income families. In the NPR-reported example of Mosaic Life Care in St. Joseph, Mo., the nonprofit hospital seized wages of about 6,000 patients between 2009 and 2013 for medical bills. One family had paid almost $20,000 through wage garnishments, had accrued 9% interest on debt from an emergency operation, and still owed almost $26,000.

Under the hospital’s financial aid terms, their income level had qualified them for free or reduced services. Their status had not been clearly communicated to them.

What is the US government investigating in 2019?

Following the NPR report, Senator Chuck Grassley (R-Iowa) launched an investigation into Mosaic Life Care. In a letter to the IRS from February 2019, the senator notes that the effort resulted in almost $17 million of debt relief. He also asks the IRS for data on tax-exempt hospital compliance with requirements regarding community health needs assessments, financial assistance policies, and patient billing.

Patient education and revenue cycle management

When dealing with life-altering financial experiences for patients and complex government rules, highly-skilled, patient-focused financial administration is a necessity. Revenue cycle management is the process an institution uses to identify and manage patient services income. In today’s healthcare landscape, a plan that incorporates clear communication and robust technology applications cannot be separated from the patient experience. It is an essential component of quality healthcare.

Who is outsourcing revenue management functions?

A 2017 Black Book survey of executives and providers from over 4,000 healthcare centers indicated that 35% of small hospitals planned to outsource their revenue management cycles from end to end by 2019. Staffing turnover adds to the reasons. Ninety-three percent of small hospital executives noted staff training is difficult in revenue cycle management transitions. The Robert Wood Johnson Foundation has also found that replacing non-physician and non-nursing employees costs 20% of annual pay.

What solutions lie on the horizon?

Third-party companies that specialize in revenue management offer a team of skilled professionals with field longevity. They focus on high-impact solutions that meet regulatory standards and maximize resource capture. In addition, they offer innovative technology that meets the expectations and needs of today’s patients. Anyone who enters a hospital should experience transparency, clarity and caring throughout the billing and payment processes. These elements, too, are among the foundations of good health.

Healthcare Claims Management (HCM) has the expertise and tools required to provide healthcare organizations with superior revenue cycle management, excellent patient experience, and real-time data and insights into your AR.  Our team is here to help.