Silos are everywhere in healthcare. While they serve their purposes, silos prevent healthcare administrators — specifically CFOs, CIOs and Revenue Officers -- from fully-leveraging their data, getting the most out of their combined teams, and implementing the most effective revenue strategy.
When it comes to healthcare payments most administrators don’t have a complete or holistic view of payments performance. Payments are viewed in line with their silos — separated as insurance payments and patients collections. Internal teams are split between denials and patient payments, which further entrenches this divide. The influences between insurance payments and patient payers, and the different levers that impact how they fit together, are hidden from view — reduced to invisible forces.
Payer performance is not separate from patient collections.
An insurance plan may have a low denial rate but may only enroll patients who are “bad” payers. A Payer may show low A/R days, but the patients it enrolls always require extended payment plans. Or, a Payer may hit on all KPIs, but their patients heavily utilize your most expensive facilities and providers.
Understanding how insurance payments behave in relation to patient payments is incredibly important and can be transformative for healthcare organizations. This level of intelligence equips providers to:
- Better negotiate with Payers
- Develop a deeper understanding of payment risks
- Control cost to collect
- Understand their geographic impact
- Track and manage utilization
- Set more strategic parameters and KPIs for third-party collections
- Understand payment trends between patient populations
Healthcare providers need to evaluate insurance payments in relation to patient payments — ensuring that they have the full picture. As healthcare payments will only become more complex, revenue cycle leaders and CFO’s need real-time access to a complete view of their payment trends.
Although there are challenges -- competing resources, IT red tape, data interoperability, etc. -- this level of intelligence should be a priority for every hospital CFO and revenue cycle leader. When you understand how Payers, their plans and patients are entangled and influenced you’re able to develop a more strategic approach to the revenue cycle.