Outsourced Medical Billing: Manage Seasonal Fluctuations

These days, outsourcing of medical billing is preferred by most healthcare organizations. The factors like advancement in technology and evolving government regulations are driving the healthcare organizations to seek assistance in Revenue Cycle Management. Outsourcing covers registration and insurance eligibility verification to claim submission and payment collections. This practice would help healthcare providers and medical billing companies in resource optimization and maximize reimbursement. The healthcare organizations must take into account the fact that seasonality has a trivial role to play in hospital and practice revenue.

The key findings of a recent study in revenue cycle management by consulting firm Crowe are as follows:

• In January 2018 (51.3 days), days in accounts receivable (A/R) were at the highest industry average for the year but showed a downward trend throughout the year. Other trends in the first quarter:
  – Hospital revenue cycle performance was also affected by 7.8% higher-than-average initial claim denials and outpatient revenue per case that was 4 percent below the average.
• April to June 2018 had stable volume and revenue through final claims and bad debt transfers increased at the end of quarter. In June, final denials and bad debt transfers were 18.5% and 8.9% respectively which are higher than average.
• From July to September, the hospital revenue cycle management performance dipped drastically. Gross revenue showed an improvement, final denials and bad debt transfers varied. From August to September, the outpatient volume decreased remarkably. In 2018, the volume of outpatients dropped by 6.4% in comparison to the previous year.
• From October to December, hospital revenue cycle performance was showed positive. There seemed an upward trend and inpatient net revenue per case was 8.9% more than average.
• Initial and final claims were lower but unstable as both denial types increased in October. Days in Accounts Receivable (A/R) were at the lowest Industry average (48.5 days) and bad debt transfers increased by 22.1 % in comparison to the yearly average.

There were a few practices changed by the hospitals and so the revenue was affected:

• End of summer potentials seems to be a rise in patient volume and revenue after the clinicians who were on vacation return.
• At the end of the year, patients may have been planning to move forward with procedure but may had to call it off due to financial constraints.
• While profits increase, practice schedules will be tight and pressures increase due to increase in patient volume in the fall.
• Revenues typically decrease once the fall rush is over, and patients again opt to reschedule care as the deductibles reset.

Most of the trends seem predictable, healthcare organizations can plan beforehand to reduce the kind of stress. In order to curb the same, the below tips can be followed as recommended by Crowe:

• It is recommended to adopt quarterly or rolling budgets more easily to anticipated changes.
• Projecting net revenue performances and the need to communicate well in advance about any pitfalls, manage volume better by educating the patients to pre-book the services as early as they can. This will definitely improve the benefits for the patients.
• Notify the patients via messaging, social media, and newsletters or through the practice website the physician schedules.
• Impose proper policies about staff vacations much before the vacation begins.
• Be attentive about collections in the fall and set aside reserves for the slower Jan-Feb session.
  Plan to tackle the strategic projects in the not too busy part of the year.
• Check and schedule the patients who are overdue for preventive services in the less busy time.
• Figure out and plan to run a smooth utilization of the next summer per se.

As the factors are clearly shows, the healthcare organizations must take steps to manage seasonal fluctuations in volume and income. This is where the expertise of an experienced medical billing company comes into picture who can support in elimination of any billing issues.