Cerner's point man on revenue cycle talks outsourcing options in a risk-based world
The times are changing – not only in how care is delivered but, equally as important, in the ways hospitals, doctors and healthcare workers will be paid.
"The regulatory landscape is getting tougher," said Caleb Anderson, who heads up the ambulatory reimbursement business for Cerner. The market for revenue cycle management is poised to grow big time – and practices and technologies are bound to change as well. "I don’t see it slowing down by any means between now and 2019."
That’s because in 2019 the Medicare Access and CHIP Reauthorization Act will create a fundamental shift in physician reimbursement. And MACRA is poised to arrive against the backdrop of health systems getting larger via consolidation, acquiring physician practices and other partnerships.
As the health system itself changes, the revenue cycle, too, is likely to evolve.
"The fundamental business model of billing services is going to get different in the next several years as you move to a capitated payment or a risk model," Anderson said.
As that shift happens, Anderson envisions a lot of hospital executives wanting to shift some of that risk to companies for revenue cycle management tools and practices, such as Cerner, athenahealth, eClinicalWorks, NextGen and Conifer, to name a few.
At Cerner, for instance, that business is called BOS – Business Office Services – not RCM. But regardless of what it’s called, it’s about revenue and how to reap all that is owed the provider.
Instead of an RCM service provider contracting with clients for a percentage of net receipts – which today is anywhere from 4 to 6 percent of the amount collected – a new model of reimbursement is likely to emerge with capitated payment.
Anderson said that one potential option is to have a vendor run the patient call center, submit claims, handle denials, and essentially take care of everything up to the point where the customer determines it’s time to turn a patient over to collections.
And there’s a perhaps less-frequently discussed upside to outsourcing revenue cycle management:
"We may be in an era where we’re helping to manage gaps in care in order to avoid that patient having an intervention or an encounter in order to maximize reimbursement," Anderson said. "I think there are a lot of things that are going to play out in the next decade to grow the RCM business model and probably fundamentally change how it’s sold in the market – what RCM means."