June 17—ICD-10 and consumerism were two key revenue cycle trends identified during the HFMA Forums networking breakfast Monday at ANI: The HFMA National Institute in Orlando, Fla.
Moderated by Forum experts Christine Fontaine and David Hammer, the 7 a.m. event brought together early risers to discuss key political, strategic, operational, and technological trends in health care—and how these developments are impacting the revenue cycle.
Some attendees expressed frustration over the myriad regulatory demands that healthcare organizations are struggling to comply with. Given all the competing priorities, many provider organizations have been directing energies to clinical and operational demands, neglecting revenue cycle developments and needs. “I talk about ICD-10 ad nauseam, but getting our clinicians to pay attention is very difficult when they have 12 other things going on,” said one Forum breakfast attendee.
However, other attendees believed that building financial pressures, in the form of decreased payments and volumes, will soon bring a heightened awareness to revenue cycle issues. “The life blood of the organization may not be patients but cash,” said Forum expert Richard Madison. “I think there’s a growing realization that we need to take a look at how we get patients through the system and get their claims paid.”
Trends to Watch
Revenue cycle trends identified during the Forum breakfast include the following:
- The expansion of Medicaid (in applicable states) and how to prepare: For example, to get patients enrolled in Medicaid, should hospitals increase the number of financial counselors or outsource the enrollment process for a few months?
- Consumerism in health care, including the emergence of online marketplaces, retail clinics, and the physician concierge business model in which patients pay directly for services
- The soon-to-be reality of ICD-10 and how healthcare organizations need to devote more time and energy to the coding transition
- The potential increase in medical necessity denials during the ICD-10 transition and how hospitals can ensure that medical necessity checks occur at the physician practice level
- Potential workforce shortages as the demand continues to rise for highly trained, skilled workers in traditionally lower-paid positions
Although they were not physically in Orlando for ANI, other healthcare leaders shared their thoughts about “Emerging Revenue Cycle Trends” on the Forum’s listserv and LinkedIn discussion boards. For instance, Maggie Adams, president, EMS Financial Services, Inc., shared this comment on the Revenue Cycle Forum’s LinkedIn page:
“Changes in payment structure will definitely have an impact, especially the movement to high-deductible health plans. Emergency providers are first to engage the patient, consequently, they will bear the burden of chasing self-pay for those high deductible plans. ICD codes have always been a sticky subject for our industry. Paramedics and EMTs … will have to provide much more detailed information about the mechanisms of injury, how they found patients, the condition on scene, etc. This information will be needed for billing personnel to appropriately code claims.”
Focus on Payment and Reimbursement
A second Forum networking breakfast will be held at ANI on Tuesday at 7 a.m. in the Forum Lounge. The topic for that session will be “Payment & Reimbursement Reform.”
HFMA Forums are networking and discussion communities for healthcare finance leaders. There are four Forums: CFO Forum, Legal & Regulatory Forum, Payment & Reimbursement Forum, and Revenue Cycle Forum.
Publication Date: Monday, June 17, 2013