Billing Information Is Essential in New Era of Affordable Care

In light of the decision to effectively uphold the Affordable Care Act, the Supreme Court has set in motion perhaps the largest policy scramble in the history of health care. The business of health services will never be the same and the reverberations of the decision and the battle to repeal it will be felt for many years to come. A growing maelstrom of opinion, analysis, adjustment and restructuring darkens an already uncertain and unstable financial outlook for independent providers and emerging technologies. Where venture capitalists and investment firms were cautious before, they may well be inactive for awhile, choosing instead to focus on larger entities and any stability they can find.

Now more than ever, diagnostic service providers must ensure that they are collecting every penny they are entitled to and not leaking cash due to holes in legacy billing systems that do not take advantage of next generation scalability, interoperability and collective intelligence.

Billing is more than just the obvious financial end of trying to collect money; in essence, it is the biggest driver of how information is going to be analyzed. As you’ll see in this new era of Affordable Care Acts and ACOs the focus will be on producing analytics that provide an assessment of economic return on investment for all of the payors, and Federal and State government. As long as Federal and State Governments are involved in healthcare, savings are their key metric.

But savings should not be just about controlling price and utilization. Savings should be derived from optimizing healthcare and providing the best results at the best price. That’s where the financials come in, and that’s why it’s important to recognize that the financial information within the billing system is now becoming essential to the practice of medicine. The shift we are already seeing in reimbursement toward value-based pricing is indicative of this increased importance. Attendant to this focus on savings is relentless pricing compression, and there is more to come from Medicare, and in other quarters. We’ve had cuts for years in the diagnostic provider community, much more than any other segment of the healthcare industry. There is much discussion about bundling and still more about capitation, but what these discussions really center on, erroneously, is finding ways to control utilization.

To optimize healthcare, it’s not about compression on reimbursement, it’s not about bundling. It’s about making sure that the right test is ordered and the right price and that there’s a value in that test. You want to make sure that the test the physician orders is providing the end result to the healthcare system, that it’s economically viable, and providing the best economic scenario for payors.