Healthcare reform law will trim the ranks of the uninsured and in the process could reduce the risk of a facility's bad debt. However, reform will do little to alleviate pressures on the revenue cycle as reimbursements are reduced and patient's deductibles increase.
The continued evolution of healthcare law will further complicate the revenue cycle through the requirement to cultivate an alignment with physicians and bundled payments. Facilities must manage the revenue cycle from both the hospital and the physician side and coordinate processes within financial clearance, eligibility, and price estimates.
Reliance on clinical or support personnel whose primary job is patient care to properly capture treatment charges, hospitals should consider hiring or training charge specialists and building expertise in specific clinical areas to ensure charges are posted correctly, and completely. However, shortages of qualified personnel in rural communities, introduces risks rarely experienced in large metropolitan settings.
Staff should consider running predictive or analytic quality checks to prevent errors and add charges that often go unrecognized.
Streamlining the charge integrity process with better workflow processes will reduce rebilling, late charges, and the confusion often experienced by payors. Concurrent processes work better than retrospective reviews and helps reduce claim review cycles and subsequent reimbursemen and all process should be documented and periodically reviewed.