Revenue Cycle Management.
RCM is the acronym for a focused, ever-evolving, highly sophisticated approach hospitals, ambulatory care facilities and healthcare systems use to suck as many dollars as possible from employers, taxpayers and insurers.
There are scores of RCM companies out there, some with programs specific to workers comp…
- Cognizant
- Resolv
- Convergent
- FIRM
- and lots more…
and this is a growth industry...
Reality is in many states workers’ comp is – by far – the most lucrative payer. Florida is the worst example of gaming by facilities to Hoover dollars out of employers and taxpayers pockets; Wisconsin is also hugely problematic as is Alabama and a bunch of other states.
And it is going to get worse.
With Medicaid enrollment scheduled to drop dramatically, CMS reducing COVID payments to hospitals, and many hospitals and health systems facing record deficits, hospitals’ scramble to find revenue is going to accelerate.
Meanwhile…bill review companies are woefully behind the Cognizants and Convergents, despite BR companies’ protestations otherwise.
Rather than seek expertise and capabilities and better performance by subcontracting to much-more-sophisticated and capable third parties, BR companies try to do it in-house…mostly so they can keep all those fees for themselves.
Meanwhile facility costs increase, and the ones getting screwed don’t seem to care. Expect Florida and Texas to be most problematic as those states did not expand Medicaid. 1.6 million Texans and 1.4 million Floridians will lose their Medicaid coverage, further hammering hospitals’ financials.
400,000 Wisconsinites could lose coverage…
Why I continue to berate the industry for failing to protect its own best interests is a puzzle even to me…employers aren’t exercised enough to demand better, neither are insurers, and TPAs are no better.
And don’t get me started on brokers and “consultants”…
What does this mean for you?
Do your job.
Joe the reality is that as long as premiums continue to move down there is no energy on the payer side to attack these issues.. If premiums begin to increase then will payers and states begin go look for cost drivers.. In the 80’s it was attorney fees. In the nineties it was over utilization. Mostly in 2000 premiums have been stable or trended downward. If this reverses in the future then the industry will start to look for cost drivers.
Thanks Todd – and of course you are right.
that said, two things occur to me; 1) payers have a fiduciary responsibility to their policyholders/clients and 2) insurers that did a very good job managing these costs would have a market advantage in terms of lower cost of medical which in turn would drive lower exodus.
Do I believe this will motivate behavior?
Sure, and I also believe in the Easter Bunny…
be well Joe