Are Decreasing Healthcare Reimbursements Hurting Your Bottom Line?

The Affordable Care Act (ACA) is decreasing healthcare reimbursements. Bottom line - CFO’s will be negatively impacted if they do not become aware of future challenges.

As the Affordable Care Act (ACA) continues to impact millions of Americans through its second year of implementation, many patients and healthcare providers are beginning to realize that nothing is as it seems. Although the ACA has provided millions of uninsured Americans with health care, it has also robbed people of their physician’s attention because doctors simply do not have enough hours in the day to complete what’s necessary for the new influx of patients.

When overstretched CFO’s are spending their time dealing with underpayments and denied claims, this takes away time needed to focus on adapting and competing in the new health economy. CFOs are ready to comply with the ACA, but the residual effects of decreasing healthcare reimbursements heavily affect day-to-day business management. As a result, many CFOs are stuck doing time-wasting work on their computers, and with ICD-10 on the horizon, it doesn’t seem like that will be stopping any time soon.

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As a CFO yourself, you probably entered the profession with a general idea of the challenges you would have to face. And along the way you probably made it through gads of “nerve wracking” moments. But, it’s becoming clear that the ACA will ultimately result in significantly lower reimbursement rates and other detrimental implications to your healthcare organization. The result? More strategic obstacles, mindless paperwork, and profit-hurdles still lie ahead.

4 challenges CFOs should be prepared to face:

  1. Claim denials 

    The Affordable Care Act has ushered in an era of increased frequency of denied claims, so CFOs have had to take necessary steps to ensure they don’t lose money from denials, monitoring every precise detail of the revenue cycle to ensure “clean” claims are submitted. Have a patient with a hyphenated last name but you forgot to include that when handing off to the insurance company? Denied. Sound familiar? And once a denial happens, your staff will need to devote anywhere between 30 minutes to a few hours to deal with it. Times that by hundreds (dare we say thousands) of denied claims and well...you do the math. That’s time you can’t afford to lose.

  2. Maintaining adequate cash reserves 

    Although cash flow has always been amongst a major concern for a CFO, future healthcare costs are still an uncertain threat to the CFO’s ability to protect the continuing operation of the healthcare organization. It’s important to note that even though it could take years for executives to adapt and accurately predict health care costs for their organization, it’s almost impossible to know what the business impact will be from the get go. CFOs will need develop a way they can determine in what order obligations need to be addressed, and provide a simply visibility into when cash will come in.

  3. Keeping pace with technology 

    The amount of technology available to leadership continues to grow exponentially and the purchasing of new technology will be a balancing act between what is a passing fad or what is sustainable. The learning curve with this new technology can weigh heavily on a CFO and the meaningful utilization of collected information can seem unnerving. So, it’s important you have the most updated technology that will provide you and your healthcare organization better predictive analytics and more information on behavioral change.

  4. Complying with ICD-10 code sets 

    By now, reading that you need to comply with ICD-10 code sets is probably starting to sound like a broken record, but it’s probably safe to say that it has ignited a big source of anxiety. When ICD-10 hits on October 1, 2015, medical providers who are not ready may face reduced reimbursements and cash flow. This disruption could result in dire financial situations if practices are not careful, so it’s pivotal as a CFO you take advantage of the resources you have now and begin preparing (if you haven’t already) as soon as possible.

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While this list of 4 challenges facing CFO’s may seem daunting and nearly insurmountable, the result could mean better quality of life for you and your healthcare organization, and hopefully, less decreasing healthcare reimbursements.

Your time is valuable. Spending your time dealing with the headache of denied claims is a complete waste of your time, energy and precious resources.  VARO supports these pain points by building a solid relationship with your team and digs deep into those denied claims so you don’t have to.  Don’t let ICD-10 and the other challenges stand in your way, now is the time to make sure your reimbursements don’t suffer any further.

5 Ways to Prepare Yourself for ICD-10 Before Your Position Goes to Someone Else

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