HIEs And Your Revenue Cycle

Healthcare has seen an extraordinary number of changes in recent years, and the one common thread through all of it—the Affordable Care Act, ICD-10, new payment models, and more—is that it all impacts your revenue cycle. The same is true of health information exchanges (HIEs).

While HIEs represent an enormous benefit regarding the centralization of a patient’s information, it will not be an easy feat to seamlessly integrate a significant number of newly insured patients into your revenue cycle.

For example, with more and more patients buying their health insurance through the healthcare insurance exchanges, it’s undeniable that much of that insurance coverage will be delivered through high-deductible, high-copay plans. This will make it hard for providers to determine exactly what kind of coverage each patient actually has and just how much of the financial responsibility will rest with the patient—especially if the provider doesn’t have comprehensive processes and technologies in place to account for it all.

Even for healthcare providers that do upgrade their RCM systems (and many will have to), receiving accurate payment—whether self pay or from insurance companies whose details about patient eligibility could be one-to-three months behind—will remain a challenge.

As with ICD-10, mistakes on both the provider and payer side are going to take place, and if the organization’s revenue cycle isn’t optimized and performing at a high level, able to withstand the lulls in payment that are sure to arise, then they may be in for a hard road.

On the bright side, those providers that do have high-performing revenue cycles in place will be in good shape to ride it all out until the dust settles.


About Kent Smith

Kent Smith

Kent leads MediRevv’s new business sales initiatives and marketing and account management programs. He has built, from the ground up, a cohesive team of healthcare sales and marketing professionals who understand the critical aspects of any engagement: exceeding the expectations of and creating value for our clients; building enduring, mutually beneficial partnerships; and maintaining transparency and a high level of trust in our execution.

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