When it comes to onboarding patients into an orthopedic practice, the initial patient access phase is crucial.  Populating your EHR/EMR and billing systems with precise, accurate, and valid patient demographic and insurance payer information lays the foundation for a smooth patient encounter and timely reimbursement—all components of successful practice operations!

The problem that often impacts patient access is using improvised automation options that have been cobbled together, mixed with using manual processes throughout.  Take prior authorizations (PAs) as an example—often required for orthopedic procedures, but usually handled through manual systems (such as phone calls and faxes) and frequently taking two to three days or longer to complete.

Improve Patient Access with These 3 Improvements

Each of these three improvements can be implemented when the patient first contacts the practice for an appointment.  By collecting this information and processing it before the patient visits the practice, you can ensure significant improvements to your revenue cycle management billing program and improve revenue captured overall.

Verifying Patients’ Insurance and Benefits

Implementing an integrated insurance verification and benefits eligibility component allows not only accurate reimbursement but also supports patients in making informed decisions about their care.  With an automated solution, limits and thresholds are readily available in real-time, allowing redistribution of staff efforts.   

Obtaining Timely Prior Authorizations 

Crucial to practice success is orthopedic prior authorizations.  Many of the treatments, medications, and surgical procedures that make up the lifeblood of orthopedics require PAs before providing care.  Utilizing an API or HL7-integrated PA solution, using artificial intelligence (AI) and machine learning capabilities, allows real-time processing and 24/7 follow-up and notifications for enhanced scheduling opportunities.

By streamlining PAs electronically, approvals can be obtained in minutes, not hours or days, and patients can be scheduled with confidence.  Bottom-line improvements are achieved through increased productivity, reduced denials and rejections, and more efficient use of staff talent.

Estimating the Patient’s Portion Due 

Patient pay estimation is becoming more critical to orthopedic practice operational health as patients absorb a larger percentage of the overall cost of healthcare.  With the advent of high deductible health plans and the shifting financial responsibilities that they bring, it’s more important than ever to have accurate and precise patient pay estimates available and to educate patients on those amounts and the practice’s financial options before care begins.

With solid expectations and ongoing training, front office personnel can be launched to collect dollars upfront and minimize outstanding amounts drifting into the AR once claims have been paid.  Not only does this increase cash flow, but it reduces collections that are more complicated to secure two or three months after care is delivered.

Automation Makes the Difference

These three solutions are automation-based, and each brings fully electronic efficiencies that would vastly improve the results recently released in the 2019 CAQH Index on Conducting Electronic Business Transactions that stated medical practices, industry-wide, that are using some form of manual insurance verification and prior authorizations, are 16% and 87%, respectively.  To illustrate, by fully implementing electronic insurance verifications, the remaining practices using manual systems would recognize total savings estimated at $4.2 billion per year.

There are significant efficiencies to be gained throughout the healthcare industry, as well as within the orthopedic specialty field by embracing electronic improvements to the overall healthcare billing lifecycle.  With advancements in AI and predictive learning, functions that were once burdensome and time-consuming can be completed in real-time with minimal disruption to the practice.

Reach out today for more information on patient access and prior authorizations for orthopedic practices.