Increasing Revenue per Visit

Solutions that Drive Big Increases in Net Collections

Healthcare providers face mounting financial challenges, driven by compressed margins, rising costs, and increasingly complex reimbursement processes. Amid these difficulties, Omniscient Health offers a transformative approach by leveraging its robust price transparency data and innovative Collection Calculator solution. Together, these tools empower healthcare providers to increase their net revenue per visit by enabling better pricing strategies and higher collection rates.

Price transparency data equips providers with critical insights into market rates, allowing them to benchmark their prices against peers and negotiate more favorable reimbursement rates with insurers. Meanwhile, the Collection Calculator provides real-time visibility into expected versus actual collections per patient visit, helping providers identify and address discrepancies. By pinpointing the root causes of collection shortfalls—whether due to coding errors, payer issues, or patient non-compliance—healthcare organizations can implement targeted strategies to optimize their revenue cycle. This dual approach not only enhances operational efficiency but also ensures that providers are fairly compensated for the vital care they deliver.

Challenges

Financial Performance Improvement Challenges for Healthcare Providers

As stated by the American Academy of Family Physicians (AAFP), physician payment updates aren’t keeping up with inflation.[1] Compressed margins are making it difficult for both for-profit and nonprofit healthcare providers to remain financially strong. For example, many nonprofit providers have ramped up investment in fundraising campaigns as operating margins are eroding with revenue waning and expenses increasing.[2]

Reimbursement rates for healthcare providers’ services have experienced flat-to-declining year-over-year changes for both commercial insurance and government-based reimbursement rates. Yet, inflationary issues have led to expenses increases far beyond the norm. To make it a triple whammy, denied payments for healthcare providers’ claims for reimbursement continue to get worse with denials recently increasing 31%.

The percentage of Medicare fee-for-service rates refers to how commercial insurance companies or other payers reimburse healthcare providers compared to Medicare’s standard reimbursement rates (one of the most widely used benchmarks). Recent trends of this metric show that both commercial insurance and government funded reimbursement rates for healthcare providers are declining. This is due to a decline from 190% to 188% in the percentage of Medicare FFS rates while Medicare rates fell.

Denial rates have steadily increased, with providers experiencing rejection rates of their claims for payment from insurers ranging from 10% to 15%. This trend not only adds complexity to revenue collection, according to experts, but also increases administrative burdens as healthcare organizations devote more resources to appealing and resubmitting claims.

In recent years, inflation has experienced a significant increase. After a relatively stable period from 2000 to 2019 where inflation fluctuated around 2% to 4%, there was a sharp and unprecedented rise beginning in 2021. This surge peaked at over 8% in 2022, marking one of the highest inflation levels in decades. The dramatic rise was likely driven by factors such as supply chain disruptions, increased demand following the COVID-19 pandemic, and rising energy costs. While inflation has started to decline, it remains above historical averages with the impact of global economic shocks on price stability and the challenges faced by policymakers in managing inflationary pressures.

Healthcare providers are increasingly struggling to navigate overly complex revenue cycle processes, a challenge made even more difficult as health insurance payers adopt advanced technologies for claims adjudication. Many providers remain ill-equipped to handle these complexities due to outdated technology and inefficient workflows. Reliance on legacy systems that fail to integrate effectively with electronic health records (EHRs) and payer platforms creates data silos, severely limiting the ability to effectively maximize collections.

Additionally, insufficient automation further compounds delays in claims submissions and verifications. High implementation costs and the complexities of integrating new technologies have left many providers slow to adopt modern solutions, putting them at a disadvantage in keeping pace with payer advancements.

To address these challenges, data analytics have emerged as a critical tool for improving claims accuracy, collections and financial performance. Organizations that invest in robust analytics platforms are better positioned to track claims in real time, identify patterns leading to denials, and optimize coding practices for proper reimbursement. By leveraging these insights, providers can proactively resolve potential issues before they escalate, minimizing denials and enhancing revenue cycle efficiency.

The complexity of the U.S. healthcare payment system creates significant challenges for providers in managing their revenue cycles. From understanding appropriate pricing to accurately estimating payments, providers face numerous obstacles that hinder their financial efficiency. These issues are compounded by the lack of transparency and technological inefficiencies, leaving many providers struggling to adapt to an increasingly complicated landscape.

Lack of Clarity in Pricing
Healthcare providers often lack a clear understanding of the prices they should charge for their services. Market rates are difficult to define due to the wide variability in negotiated reimbursement rates among insurers and the limited standardization across the industry. This uncertainty leaves providers without a reliable benchmark for evaluating the financial value of their care.

Challenges in Knowing How Much to Collect
Adding to this difficulty is the challenge of knowing how much to collect for each patient encounter. With multiple insurance providers offering varying coverage levels and patients assuming increasing out-of-pocket responsibilities, providers struggle to accurately estimate the amounts owed. The absence of efficient, real-time systems to manage these variables exacerbates delays and inefficiencies in revenue collection, contributing to administrative burdens and financial strain.

Solutions

Healthcare providers can address the growing pressures to optimize their financial performance in an increasingly complex payment landscape by leveraging price transparency data and adopting Omniscient Health’s Collections Calculator to increase revenue per visit.

Price transparency data is used to gain deeper insights into market rates for healthcare providers’ services. By understanding how their pricing compares to other providers in the region, healthcare organizations can make informed decisions to negotiate more favorable reimbursement rates with insurance companies. This knowledge empowers providers to close the gap between underpayment and fair market value, which is essential for sustaining financial health in a competitive environment.

Additionally, the Collection Calculator offers real-time calculations of expected versus actual collections per patient visit and can significantly enhance revenue cycle performance. This tool allows providers to quickly understand reasons for differences between what they should be collecting and what they ultimately receive. Claims adjudication data is utilized by the Collections Calculator to identify and summarize key reasons for collections shortfalls across heath insurance payers. By addressing these gaps, providers can increase revenue per patient visit and strengthen their financial foundation.

Additionally, the Collection Calculator offers real-time calculations of expected versus actual collections per patient visit and can significantly enhance revenue cycle performance. This tool allows providers to quickly understand reasons for differences between what they should be collecting and what they ultimately receive. Claims adjudication data is utilized by the Collections Calculator to identify and summarize key reasons for collections shortfalls across heath insurance payers. By addressing these gaps, providers can increase revenue per patient visit and strengthen their financial foundation.