Revenue Cycle Yearly Jan – Dec 2021

Ripun Jai Mehta

Managing Partner
ripun.mehta@novistra.com
(646) 645 1935

Pankaj Arora

Managing Director
pankaj.arora@novistra.com
(917) 460 0659

Peter X. Li

Managing Director
peter.li@novistra.com
(917) 250 8605

Anuj Jaisinghani

Vice President
anuj.jaisinghani@novistra.com
(437) 234 1151

Legislators float bill to extend and expand telehealth

The US Congress passed the Telehealth Extension Act of 2021 that would extend and expand access to telehealth services in the Medicare Program while imposing certain requirements for high-cost services. The Act would remove geographic and site constraints on Medicare enrollees’ access to approved telemedicine services and would provide clarity, certainty, and a framework for developing a telemedicine system that increases access, protects patient choice, and includes fundamental fraud and exploitation precautions.

Additionally, the Act would create a 2-year extension of the COVID-19 emergency telehealth waiver, permitting new types of providers to supply telehealth, including audio-only options. Telehealth services will also be available to federally certified health centres, rural health clinics, Indian Health Service (IHS), and Native Hawaiian Health Care Systems.

Finally, in the event of a disaster, the bill gives the CMS broad discretion to authorize further telehealth flexibility. The Act received support from more than 15 organizations, including key leaders across the healthcare community, and already has 30 bipartisan cosponsors.

Optimizing financial clearance is priority during the pandemic

Financial clearance, including patient identity verification and eligibility checking, has helped both providers and patients to overcome operational challenges during the pandemic. It has increased revenue from both payer and provider by ensuring data accuracy to prevent denials, identifying those patients that are likely to pay, and connecting patients who need financial assistance with the proper programs.

Organizations need to follow three important practices to ensure that patients can quickly obtain maximum funding with minimal effort:
(i) Screen every patient for eligibility – identify self-pay or uninsured patients and screen them as soon as possible;
(ii) Utilize automation to identify funding sources – enter patient response data into an automated program able to identify and submit applications, increasing efficiently;
(iii) Monitor performance metrics – review performance metrics in real time, make adjustments, and implement ongoing improvements to ensure that patients receive funding and that healthcare organizations are reimbursed in a timely manner.

If followed correctly, optimizing financial clearance can be a strategic advantage for driving improved revenue metrics, market share, and patient loyalty.

Migration to cloud-based RCM boosting technology spending

Cloud-based technology spending is becoming increasingly necessary in the US healthcare industry as it allows organizations to move from in-house, high-cost infrastructure maintenance to a “pay-for-what-you-use” model. With flexible and scalable capabilities, health clouds reduce IT complexity and decrease costs while enhancing resource utilization and service delivery.

By 2024, healthcare organizations are projected to spend an estimated $50bn on technology investments, with cloud driving much of that expense. The global market for cloud technology in healthcare is expected to grow by more than $25bn between 2020 and 2024.

While adopting a cloud server can save organizations from purchasing costly infrastructure in the future, frontend cost such as PaaS platform deployment and IT managed services can get expensive.

Therefore, it is critical to weigh the short-term expenditures against the long-term ROI for cloud migration. Before migrating to the cloud, it is important to review all unforeseen costs, as the total cost paid for cloud services should cover customer satisfaction, performance data security, and compliance.

Value-based payment models leading to better care quality

According to a recent Humana study of Medicare Advantage (MA) members, MA patients receiving valuebased care received better overall health outcomes, as well as lower costs and more preventative care.

The report found that 67% of Humana’s individual MA members sought care from primary care physicians in valuebased agreements, considering that, as of December 31, 2021, about 67,800 primary care physicians had value-based contracts with Humana.

A vast majority of Humana ‘s MA members (approx. 90% of 4.6mn members), had at least one chronic condition, while approx. 83% had at least two chronic conditions. Humana pointed to these statistics as evidence that value-based frameworks are appropriate for these populations, given that the care model is more focused on prevention.

Humana’s value-based proposition achieved an estimated medical cost savings of 13.4%, compared to volumebased Medicare. Preventative care helped lower the usage of acute care services, and value-based physicians reduced avoidable hospitalizations by 11% over their fee-for-service counterparts.