The Impact of Government Regulations on RCM

Government regulations have had a strong impact across the healthcare industry. Some of these effects are due to HIPAA, the Healthcare Insurance Portability and Accountability Act. Other issues have more to do with the way the industry is transitioning to a value-based reimbursement model from the historical model of fee-for-service. No matter the reason, however, there is no doubt that there is hardly an area of healthcare that has gone unaffected, and revenue cycle management (RCM) is no exception.

Medical debt and the CFPB.

One of the most complex and wide-ranging areas of government regulation as related to RCM is how it affects patient collections, specifically regarding the ways in which medical debt can be collected. The Consumer Financial Protection Bureau (CFPB) has been at the forefront of a number of these changes, sparked in part by consumer watchdog groups and the CFPB’s own research. Some of the facts that have come out of that research into were surprising to many. For instance:

• Over half of all collections on credit reports are associated with medical debts.
• Many consumer complaints to the CFPB indicate that they didn’t know they had a medical debt in collections until they got a call or discovered the debt on their credit reports.
• The vast majority of medical debt reflected on credit records is reported by third-party collection agencies.
• One in five consumers with a credit report has a medical collections item.
• Fifteen million consumers have medical debt collections items as the only collections items on their credit reports, and many of them have no other seriously delinquent accounts.
• The average balance of medical collection accounts is $579 and the median is $207.

How providers can proactively address issues that are the result of government regulations.

The key to success for any provider within the framework of government regulations is to create a workable system within specialized areas of their RCM (i.e. patient billing and collections) that addresses potential issues before they even arise. This means finding additional ways to keep patient medical expenses out of collections in the first place.

To that end, the Healthcare Financial Management Association (HFMA) and the Association of Credit and Collection Professionals (ACA International) issued a joint report on best practices for medical billing and found the following steps to be helpful, and all can be integrated into the RCM cycle to simplify patient billing and collections:

• Bills should be clear, concise, correct and patient-friendly.
• Communication with the patient regarding financial responsibilities should be handled prior to service and discharge.
• Providers should take the initiative/opportunity to educate patients at every step of the account resolution process.
• Emphasize the shared responsibilities of both sets of parties (provider and patient) to provide information relevant to account resolution upon request, to speed claims processing.

Unfortunately, even the most experienced patient billing and collections staff can only do so much to ensure full payment of patient financial responsibilities within a reasonable timeframe. This is why controlling whatever aspects of a practice’s financial health can be controlled has become so important to successful practice management. It’s also why many practitioners have chosen to integrate Aquina’s Via solution into their RCM process. Via is a tool that expedites insurance claim reimbursements so providers can be paid faster. With integration already in place with leading EHR providers such as athenahealth and Kareo, getting started is easy. Contact Aquina Health today and find out how.