HIEs And Your Revenue Cycle
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.