Treating the Patient as a Payer

The rise of patient financial responsibilities in the healthcare industry is fundamentally changing how providers think of the revenue cycle, says an executive with claims clearinghouse and revenue cycle management vendor Emdeon.

“You have to start treating the patient as a payer now,” Jim Riley, general manager of revenue cycle management told Health Data Management during an interview at HIMSS15.

Providers need to take new looks at clinical and financial data to identify nuances of a patient’s financial situation and how the insurer will cover a procedure before a physician sees the patient, Riley believes.

Providers will have to present the patient with a “working diagnosis code” to ensure appropriate tests and treatments are conducted to meet quality metrics, which will affect revenue. Providers will have to present “actionable intelligence” including likely needed tests and treatments to the physician before he or she enters the room to ensure quality metrics are presented and reported, he adds.

During HIMSS, Emdeon debuted new patient payment responsibility estimating software for the ambulatory market.