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In this time of Healthcare transformation, provider organizations must develop a strategy to better manage bad debt and help patients understand their new health insurance plans. The Affordable Care Act provides for every American to have health insurance, and the new health plans will increase the patient’s financial responsibility and possibly narrow their network options. The increase of patient financial responsibility will ultimately increase bad debt for provider organizations. Simultaneous to this issue, the Centers for Medicare and Medicaid Services (CMS) have implemented reductions to Medicare’s bad debt reimbursement, so providers must manage their financial strategy closely to address these revenue reduction areas.
Provider organizations need to seize opportunities in creating fundamental changes in strategy for clinical operations, revenue optimization, and system integration in order to stay competitive. These strategies must all focus on engaging the patient by providing education on insurance benefits, better outcomes and reducing overall cost of care.
The guiding principles for patient engagement begin with education and community outreach. A focus on patients that have received charity care in the past to provide guidance and education on qualified health plan (QHP) enrollment is a good starting point. Educate them on the plan’s preventative opportunities, network options, and financial commitments. Engage entire families in the educational outreach so members can help each other.
The Patient Engagement Framework details the approach and collaboration processes that can assist patients with their insurance and healthcare needs. Leveraging this framework, an effective strategy can be developed that will educate the community, empower the staff, improve the processes and positively affect hospital collections. Patient Engagement is possible and will become an increasingly important driver for healthcare organizations to remain competitive.
A key investment area for patient engagement is information technology. Developing a defined strategy to take advantage of technology enabling tools and processes will support Patient Engagement so benefits are realized. Patient portals, mobile applications and web based communication are just some examples of IT enabled tools that will support increased patient engagement.
Patient engagement will increasingly become a driver in revenue cycle management. Healthcare providers and payors must find ways to successfully educate, engage and collaborate with patients and each other to protect revenues, improve case outcomes and reduce overall cost of care.
Carla Fischer, M.S., is a Consulting Manager who is an expert in Healthcare enterprise transformation programs. She has successfully built and managed partnerships with large organizations including hospitals, payors, patient financial service vendors, clinical laboratories, and academic institutions. To find out more about how MSS can help your organization improve patient engagements, contact us at firstname.lastname@example.org.
Cite this blog post:
MLA: Fisher, Carla “The Role of Patient Engagement in Today’s Revenue Cycle.” MSS. MSS. Blog. 08 April 2015.
APA: C Fisher. (2015, May 8). The Role of Patient Engagement in Today’s Revenue Cycle.