Three of the greatest revenue cycle management challenges are Medicare and Medicaid payments, claims denial and value-based payments.

Medicare and Medicaid Payments: Complicated payment reforms, decreasing reimbursements and government mandates promote the delay and denial of obligations for services covered by Medicare and Medicaid. Medicare and Medicaid represent an ever-increasing sector of the populace and timely and adequate payment from these associations rank as a leading issue for health care professionals. The Centers for Medicare & Medicaid Services (CMS) have significantly increased provider education tools such as on demand webinars and other tools j code cpt list.

Claim Denials: Some health care organizations say 25% of their claims are denied. Some for a technicality like a missing signature on a medical chart, an erroneous spelling or conflicting data entry. Sixty percent of health care organizations did not observe a revenue impact, from the current implementation of ICD-10 but 34% reported that they did in a recent post ICD-10 survey. Continue to keep an eye on your denial trends so patterns can be triaged and treated early on from the origin the symptom. Additionally note while you are able to submit a valid identification code in the right family and get potential payment, you might not observe the same after October 1, 2016, since coding to the correct degree of specificity will be required.

Value-Based Payments: ACA brought from the transition from fee-for-service to value-based payment model. The intent is to enhance the quality of health care services being supplied to patients accordingly healthcare providers are paid depending on the worth of care they provide rather than being paid for the amount of patients’ visits or tests ordered. This means healthcare practices need to reconcile the new payment model with the traditional fee-for-service environment changing analytics and metrics to ensure payments cover costs.

In addition, the U.S. Department of Health and Human Services (HHS) announced that by the end of 2016, 30% of Medicare reimbursements will be linked to the “quality or worth ” of providers and 50% from the end of 2018. Penalties for not enhancing data quality include a docking of two% of Medicare reimbursements.

The 90-Day Grace Period

Another factor impacting revenue cycle management is the eighty-five percent of patients who received an advance premium tax credit through the ACA rules. They are eligible for a 90-day grace period to cover their outstanding premiums before insurance companies can drop their coverage. This rule applies to all customers that purchased subsidized coverage through the Affordable Care Act’s (ACA) health insurance market. It has the potential to be a issue not only to monitor patients in this circumstance but in the delay of payments. Identify if your patient is up to date on their premium payment as part of your registration procedure.