The following is a guest article by Matthew Bayley, M.D., Group President at Conifer Health Solutions.
Physician practices have been especially hard hit by the pandemic. On the positive side, net patient revenue and provider productivity have started to increase. But those gains have been upended by inflation and skyrocketing costs. A July 2022 report by Kaufman Hall says that total direct expense per provider FTE is up 2.2% quarter-over-quarter and 7% year-over-year. The same report highlights the challenges around staffing as well, stating, “When adjusted for productivity, staffing levels continue to decline QOQ, with Support Staff FTEs per 10,000 wRVUs down 4.8% from Q1 2022 as open roles are going unfulfilled.”
The staffing shortage is a challenge practices should expect to continue. In 2021, more than 330,000 healthcare providers left the workforce—117,000 physicians, 53,295 nurse practitioners, 22,704 physician assistants, 22,032 physical therapists, and 15,578 licensed clinical social workers. While there has been talk for years about an impending shortage of physicians and nurses, stress and burnout from the pandemic have only exacerbated the issue.
Practices can help offset the impact of rising costs and lower staffing levels by shoring up key revenue cycle processes. This means removing inefficient manual processes and automating where possible. The following is a list of opportunities to do just that.
Eligibility and Coverage Verification
Most rejections and denials stem from issues in the patient access process—primarily missing or incorrect eligibility information. Leveraging technology to automate eligibility verification can eliminate the time-consuming process of calling payers (and sitting on hold) or searching payer websites for patient information. Automating these highly manual, error-prone processes can alleviate the stress on existing staff and may enable practices to reassign staff to more strategic initiatives.
Self-Pay Collections
A report by Credit Karma found that its customers took on $2.2 billion in additional overdue medical debt during the pandemic, reaching a record-breaking $47 billion. This means self-pay collections have become more challenging than ever. It’s no longer sufficient to take a reactive approach to collecting; practices need to do all they can to make it easier for patients to pay. One of the best ways to do this is by providing patient responsibility estimations, preferably before the time of service. Having this detailed information about what their insurance will and won’t pay for helps patients make more informed decisions about when to get care and how to pay for it. It also enables the practice to have a more productive conversation about the patient’s responsibility and payment options. This, in turn, can improve the patient experience while helping practices get paid in full.
Claims Coding
Of all revenue cycle processes, coding is the one that can significantly impact many different aspects of a practice’s success: denials, patient experience, cash flow, and the revenue stream. Coders need to understand how the quality of their work impacts the practice’s bottom line. The problem, however, is that coding has become increasingly complex and burdensome, with an overwhelming library of more than 78,000 codes. Simply staying up to date on new codes can be a herculean undertaking. Besides ensuring coders attend continuous education programs, practices can also leverage technology that filters and flags claims with issues so they can be fixed and resubmitted before hitting the payer’s adjudication system. This can keep issues like rejections and denials from happening in the first place.
Predictive Analytics
When practices are short staffed, it can be difficult to prioritize process improvements. Yet, that’s when process improvement becomes most valuable. In the past, tracking and analyzing practice data was a highly manual, time-consuming process. But that’s no longer the case. Predictive analytic software gives practices critical insight into the practice’s performance while providing insight into payer behavior as well. For example, it makes little sense for staff to be working accounts within two weeks if that payer doesn’t remit until day 14. Or if a certain payer’s claims are more likely to be rejected, it may be an indication that the coder handling that payer’s claims needs additional education. These insights can be instrumental in helping practices work smarter, not harder.
Consider Outsourcing
For many practices, it can be more cost effective to partner with revenue cycle experts to help improve revenue cycle processes rather than taking it on themselves. When making the decision whether to outsource, practices need to take an honest look at what their existing staff and technologies are capable of. With the right partner, practices can achieve operational improvements more quickly than they could achieve on their own. This should be taken into consideration when deciding whether to outsource. It’s not just about the fee; it’s about the return on investment and how quickly that return can be realized.
A New Normal
Staffing challenges aren’t going to magically go away once the pandemic has finally disappeared. Likewise, the impact of inflation and rising costs are sure to be felt for some time to come. Yet, even with these challenges, physician practices can grow revenue and protect their bottom line by improving revenue cycle processes to achieve optimal practice performance. Partnering with revenue cycle experts can help them reach their strategic goals faster and with fewer resources. It’s a new approach for a new normal.
