Medclaims

By Arthur Roosa, CHBME – 06/22/2016

OK, so you’re a billing service; but are you? You think of yourself that way and you work with your clients that way.
Heck, you even plan that way! Now you need an association that will help you be more successful, relevant, and
impactful to your clients. An association that will uncover ways to help you run a more efficient shop, better track
denials, increase collection percentage, and become a superstar to your client base.

Then your client gets bought out by a hospital and you begin to wonder where you went wrong. Getting them back is
only a matter of time, no? The hospital can’t really do the work. The collection percentage is plummeting but nobody
seems to care. Well, welcome to the brave new world of revenue cycle management, where data reporting is as
important as claims submission. Where total net revenue trumps total collection percentage. Where traditional fee
for service claims submission is so automated, that the major players are charging 2 percent and making a very
good living at it.

So, what is a billing service owner to do? Health care is evolving quickly, but not overnight. The superstar you’ve become with
your collection percentages is important, and continuing to do so with more efficiency and better outcomes is crucial to the
health of your business and that of your clients. You cannot survive without doing this or by doing just this longterm.

Needing to be the aforementioned superstar amidst the evolving healthcare industry is not a change that has occurred, nor is it
one that will occur this year or probably the year after. So it is more than tempting to turn a blind eye to the changes afoot, focus
on what you do (and have always done), and celebrate the positive effect you have on your clients, staff, and, ultimately,
yourself. But to quote a 60s song, “a change is gonna come.”

You could use assistance and guidance on how to be better at claims submission and collections, increase revenue per FTE,
and reduce days in AR—all of this with lower costs. HBMA itself cannot turn a blind eye to this need. But, on the horizon is a
sea of change in how we must do business and we, as billing service owners, must prepare for this change while providing
traditional services at a very high level.

So let’s talk some about this change and how it alters and integrates into what we currently do. First off, feeforservice
billing is not likely to disappear. There is likely a place for the traditional billing service moving forward. Now, 500 billing services just
read that line and said, “Whew—that’s me.” Well, for a few, that’s true. However, for the majority of those reading this article
who believe they will be that traditional billing service that continues on for many years to come, you are indeed rolling a pair
of very unfriendly dice. For the rest of you, and for those that are not quite so sure about those dice, let’s take a deeper dive.

Payforperformance and alternate payment models focus on clinical outcomes and population health. Although a discussion
of these developments is beyond the scope of this article, suffice it to say that provider payments are focused on the reporting
of ancillary services and/or the overall wellness of the population assigned to a practice. This is qualitatively different than
billing a service that was performed and expecting a certain payment for that service; it requires the ability to analyze data.
MIPS (Meritbased Incentive Payment System) adds an even greater need for analytics as providers will be compared against
each other, not an objective standard. Thus, we will need to track our clients’ performance against those of their peers and
help them understand how they may improve and increase their reimbursement. We need to become more managers than
billers, more analysts than collectors. This will alter what many of us currently do.

Remember, this is not an overnight change, but this isn’t a futurist vision either. Medicare wants 80 percent of practices in an
APM by 2018. Whether or not this is achievable is not the issue. Rather, it is the direction that CMS is pushing and is unlikely to
reverse course from. It is important that we, as billing service owners, make this shift with them to stay relevant and viable.
There are many services that we, as an industry, can profitably render in this new world: Reporting and tracking of quality
measures, comparative analysis of our clients’ performance against their peers, consultation and advice of how to increase
reimbursement, data reporting of average reimbursement for a given set of services, and so forth. And, of course, the
submission of the actual encounter data itself. We would do well to consider ourselves business managers as opposed to
billing managers and market those additional services that clients will increasingly come to need. These are services that
might be integrated into the suite of services we already offer. Indeed, for some, it might not represent much of a change.

So, are you a billing service or a business service? Should HBMA focus on education that helps you be more successful at
submitting and collecting claims, or managing the revenue side of a practice? Well, the answer is both in each case. But you
cannot be just a billing service, unless you choose to roll the dice and ignore the direction that health care is taking (in this
case I wish you the very best). You may indeed be the one that builds and grows a successful business on feeforservice
submissions. But for the rest of us, well, “a change is gonna come.

Stay informed about up-coming Medicare changes – “The Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs)” Click HERE  for details.

“Fresh problems for Obamacare.” Click HERE  for details.

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“The Obama administration is finally giving employers the rules…” Click HERE  for details.

“A federal judge ruled Thursday against the administration in a challenge…” Click HERE  for details.

“There are many different factors that go into the cost of health insurance…” Click HERE  for details.

“…We saw this coming years ago…” Click HERE  for details.

“If UnitedHealthcare follows through on its threat to quit the health insurance marketplaces in 2017,” Click HERE  for details.

“Health insurance premiums have increased faster than wages and inflation in recent years, rising an average of 28 percent…” Click HERE  for details.