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Revenue at risk: new collection challenges mount

Providers have to ramp up management of their revenue streams with ICD-10, higher deductibles on horizon
By Frank Irving
04:28 PM
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Healthcare organizations need to adjust to shifts in the way revenue is collected — and a fistful of coming changes, including ICD-10, could make things more difficult.

"The old days of patients walking out of a practice without paying a single dime, even for the co-pay, are long-gone," says Jeff Wood, vice president of product management for Navicure, a claims management and clearinghouse firm based in Duluth, Ga.

With the continued trend toward higher health plan deductibles, more and more dollars will need to come directly from consumers' pockets.

"About 30 percent of practice revenue now comes from individuals as opposed to other sources," Wood explains. "Practices need help in making that big transition."

Given that deductibles typically reset on January 1, the first quarter of the year will be a key time for managing collections. Navicure introduced a collections product for practices last fall. Wood said it has gotten solid traction in just the few months since its release and he expects it to draw high interest at HIMSS15.

Another core area for the company will be helping clients make the switch to ICD-10. Wood characterized customers as being a "mixed bag" in terms of their preparedness for the October 1 deadline.

"We have some that are ready — and have been ready since the original deadline in 2014," he says. "But there are a few who are certainly going to wait until the last minute and white-knuckle it out over the summer. We continue to educate and train them that this is something they're going to have to do."

Navicure also offers a tool that enables practices to code in ICD-10 and derive ICD-9 codes in an automated fashion. The software will come into play if, as Navicure expects, not all payers will be ready to handle ICD-10 codes at the deadline. That scenario has the potential to be "pretty disruptive" on the practice side, according to Wood.

In addition to basic collections and coding, Navicure plans to have discussions, particularly with larger practice groups, about analytics and business intelligence tools.

"It really comes down to making sure that practices are as efficient as they can be. They may need some help in terms of understanding how they stack up against other practices, determining how efficient they truly are," Wood says. "At this point the prudent move is to prepare as if there won't be a delay in the transition date. Obviously things will have to adjust if Congress fools us all."

Those dialogues will likely happen at HIMSS15 for Navicure and continue later in the year.