Thursday, December 2, 2010

Why Don't Providers Collect What They Expect? - In reality

Why Don't Providers Collect What They Expect?

Health care's patient, provider, and payer structure makes accurately predicting revenue collection a particularly difficult challenge. While all three stakeholder groups may be well intended, they simply do not value health care services similarly because of the differences in their individual needs, wants, and approaches to risk management.

Governance of this marketplace is achieved through a large volume of legislated regulations and procedures, and many providers surprisingly jeopardize revenue collection by not understanding the full range of reimbursement rules. Current budget and demographic trends will only increase pressure on the entire health care delivery system into the foreseeable future.

Revenue predictability requires that individual lines of business and their unique revenue streams be understood and managed. Providers should fully recognize patient encounters as the "activities" that drive internal service, cost, and outcome processes. Predicting and actively managing what should be collected for individual encounters should take place before claim denials occur, not after.

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