One thing you can count on in the healthcare industry is change. Whether from governmental reforms and regulatory changes or insurance payer restrictions and reimbursement alterations, it is up to the providers to adjust and thrive. In cardiology, finding ways to improve patient access can lead to improvements in bottom-line results through a more efficient workflow.
Using state-of-the-art intelligent technology, today’s cardiology practices can improve both the provider’s workflow and the patient’s experience while increasing the revenue received. By focusing on the patient access portion of the healthcare billing lifecycle, you can ensure accurate information for both patients and insurance payers, collect the appropriate amount before the patient is seen, and have prior authorizations completed in real-time.
4 Ideas Whose Time Has Come
Starting with the premise that technology and smart automation is changing the way business is done today, cloud-based solutions that can be integrated into the cardiology EHR/EMR through secure HL7-coded language (that’s also HIPAA compliant) to bring functionality to a whole new level. Let’s look at these ideas individually:
- Improved patient scheduling through AI-driven prior authorizations (PA). Imagine taking the most burdensome and difficult individual process in a cardiology practice and streamlining it to be fully automated. Using automation and AI-driven technology:
- requirements are determined at the outset of the patient scheduling process (cutting as much as 30% of the total PA time),
- PAs are generated and submitted to the appropriate insurance payer through a unified interface; and
- automated follow-up can continually check the PA’s status, notifying, and updating staff in real-time.
The reduction in clinical and administrative time can reduce the costs by as much as $9.04 per PA (2019 CAQH Index). For a 10-provider practice generating 15 PAs per provider per week, this would be an estimated annual savings of $70,512.
- Automated, real-time electronic insurance eligibility and benefits verification that tracks and confirms precise, timely patient coverage details in seconds. Without first knowing crucial information like eligibility, remaining deductible, out-of-pocket maximums, and deductibles met, it is impossible to provide your patients with an accurate estimate of their portion. Further coordination of benefits will refine this process even deeper, ensuring up-to-the-minute accuracy.
- Provide patients with an accurate patient responsibility estimation using real-time automation. Along with knowing the patient’s critical insurance eligibility information, it’s essential to obtain a precise patient pay estimation and to have the policies and training in place to collect before the time of service, if possible. Money collected upfront can be adjusted later when more details and clarity emerge from the patient’s treatment plan, but it is infinitely more difficult to obtain after the fact. After returning to health following excellent care from your practice, the sense of urgency to pay is gone, and payment often becomes less compelling.
- Active participation in the Clinical Determination Support Mechanism (CDSM), including Appropriate Use Criteria engine that complies with the Centers for Medicare and Medicaid Services. The current year 2020 Educational and Operations Testing Period is underway, and payment consequences will be mandatory as of January 1, 2021.
AI-driven software is front and center as a solution for this potentially cumbersome requirement and can respond in real-time both proactively and reactively to the patient’s treatment and referral. Whether your practice or group is providing advanced imaging procedures, or you are the referring provider, you have an obligation to participate in this program and issue compliance certificates for all Medicare patients receiving advanced procedures.
As you examine ways to meet the challenges brought by declining reimbursement and growing patient consumerism, remember that improving automation solutions can make monumental leaps forward for your practice operations. PA improvement alone can create significant financial contributions to the bottom line but also alleviate considerable provider frustration and administrative workflow…not to mention, improve the patient experience.
Contact us and learn how cardiology practices can benefit from advanced patient access automation techniques.