The Challenges of Patient Billing for Community Hospitals

Nearly 60 million Americans rely on their small-town hospital for healthcare. However, in the last eight years, 83 rural and community hospitals have closed their doors for good, according to a report by the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.

It’s estimated that another 700 hospitals are vulnerable to closure over the next 10 years. Some of the struggles faced by these hospitals are due to challenges related to revenue cycle management. In fact, a 2021 report by The Chartis Group revealed that 41 percent of rural hospitals are operating on negative margins.

While it’s true that hospitals of every size experience challenges with revenue cycle, community hospitals are faced with a unique set of obstacles when it comes to financial stability. Physician shortages and higher rates of disadvantaged patient populations can be two distinct hindrances. In addition, rural hospitals have historically relied on Medicaid and Medicare reimbursements as primary payers—but the industry-wide shift to a value-based reimbursement model means that rural hospitals are often excluded because they lack the sufficient patient volumes needed to succeed. Low patient volumes can distort quality performance metrics—the benchmark for reimbursements—which can then cause a rural hospital’s reimbursements to decline.

As patients become increasingly responsible for out-of-pocket healthcare costs and reimbursements dwindle, hospital revenue cycle teams—specifically those at small and rural hospitals—are under more pressure to process claims, issue patient statements, and collect payments faster. However, these hospitals oftentimes have limited access to newer technology, and older operating systems may not efficiently provide the data for managing those crucial processes that affect a hospital’s financial health.

Rural hospitals deserve access to smarter tools and technology that can help them improve cash flow, keep budgets on target, and better manage the revenue cycle. Here is where MEDHOST can help.

Designed with the unique challenges faced by revenue cycle professionals at rural hospitals in mind, MEDHOST’s revenue cycle applications can help them address common barriers to improved financial performance.

1. Effective and efficient patient account follow-up: With increased visibility of patient statements statuses, hospitals can see when charges, payments, and adjustments have been made to the account. An Online Bill Payment function allows patients to make secure payments online, plus view their account information and statements all from the convenience of their smartphone or computer. Revenue cycle management teams can electronically send Health Care Claim Payment/Advice files through an electronic remittance application, which eliminates the need for manual data entry and makes the claims reconciliation process quicker.

2. Enhance productivity and decision-making: Our staff’s expertise can enhance productivity by helping with the overflow of insurance follow-up, billing, and cash-posting. For those hospitals looking for additional help, contract management assistance is a simple way to ensure accurate reimbursements and to more easily reconcile payments with insurance carriers.As an added bonus a Document Management System (DMS),  gives healthcare professionals the flexibility to securely manage healthcare financial and clinical information online.
3. Revitalize your old strategies: As part of the full-on enterprise solution, the Denial Management Module helps hospitals better identify, resolve, and prevent claim denials. The denial management module includes data capture, denial categorization, and other workflow and reporting tools. Powered by smart metrics and data analysis, hospitals can gain a competitive edge to improving financial and operational performance.

Updated: May 4th, 2021

Read on for more about how MEDHOST can help your hospital facilitate accurate claims, improve financial health and performance, and enhance productivity among revenue cycle teams.