Revenue Recovery

The industry is in a huge state of flux, and we have our payer sources to thank for it. We now live in a world where we deal with competitive bidding and oxygen caps, and it seems like almost every day we are threatened with more. Medicare audits, further reduction in the cap months, accreditation requirements and other items that will either cut reimbursement or increase costs keep coming.

While all our eyes and attention are on Medicare, we also continue to get hammered by the other payer sources.

Medicaid cuts and changes are occurring across the country. In the quest to do more business with non-governmental payers, providers are tapping into commercial insurances. Along with the growing need for sleep therapy, for example, there is a growing patient base with commercial insurance. But this, too, is riddled with issues.

Many of these payers require providers to be contracted with them and limit how many they will allow in their networks. There is little or no negotiation power with their aggressively low reimbursement rates.

Then there is the final blow. What some may fail to realize is that commercial payers are further whittling away at providers' bottom line through higher deductibles and copays. (HME providers who offer health care benefits to their employees understand this all too well.)

To keep insurance premiums down, cost-sharing is up for the patient. High-deductible health plans are a way of life for many, and as the burden shifts to patients, it also becomes a larger burden for their health care providers.

As a provider, you must now learn how to collect from the patient — and that is a whole different ball game.

The Devil Is in the Details

The time has come when you must pay attention to recovering all of your revenues, especially patient-owed receivables. Often, providers may ignore these for reasons like:

• “It's just small dollar amounts.”
• “I don't want to upset the referral source.”
• “I don't have time to deal with it.”
• “I don't have a problem. The elderly are conscientious about paying their bills.”

The fact is, most providers are shocked after taking an honest look when they realize how much money these receivables can represent.