Healthcare operations — It’s a broad category that includes everything from patient onboarding to the financial reimbursement process. One thing is for sure, constant stewardship is required to maximize current processes and make improvements when new technologies become available.

Our focus has rightfully become the patient’s expectations, and whether you are invested in hospital operations, diagnostic testing facilities, or are responsible for a physician practice or group. Providing convenience and efficiency for patients continues to rise in importance with the development of technology that increases access. It’s important to focus on engaging patients and creating quality experiences that begin with the onboarding process and follow through until the last dollar is collected.

Finding Solutions to Inefficiencies in Healthcare Operations

From the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for all hospitals, to the individual insurance payers monitoring physicians and practices through various surveys and assessment tools, it seems that everyone is invested in monitoring patient satisfaction. With that in mind, let’s explore eight opportunities to improve each encounter.

Patient Access or Onboarding

Patient access or onboarding is the process of welcoming new patients, registering them with accurate information into your system, and orienting them with financial expectations. Onboarding also includes meeting any insurance payer requirements, such as ensuring prior authorizations are obtained for procedures, tests, and medications.

This is often the first impression of your organization and sets the tone for all future interactions. It’s critical to make this process smooth and seamless.

  1. Make the Patient’s Initial Encounter as Effortless as Possible — When the patient first engages with your organization, are they able to provide information through a patient portal or email system? Patients of all ages are comfortable with technology; with providing private information if they feel it will be handled in a safe, secure manner.
  2. Be Sure You Use State-of-the-Art Insurance Verification and Benefits Eligibility — While verification can be done through each insurance payers’ portal or website, consider an insurance verification and eligibility system that is resident within your organization and has access to clearinghouses of up-to-date insurance benefits information. There may be additional benefits if the system integrates electronically with other components, such as prior authorizations or insurance discovery tools.
  3. Educate the Patient on Financial Expectations — As part of the onboarding process, it’s important to educate the patient on policies and expectations when it comes to collecting the patient portion due. With an integrated system that provides that estimate immediately, the business staff can collect the amount due upfront alleviating any problems after the fact.
  4. Streamline the Prior Authorizations Process — Prior Authorizations (PAs) are more commonplace than ever and continue to grow. Instead of using a manual PA system that relies on telephone calls, faxes, and painstaking follow-up. Consider an automated prior authorization software that can identify needs, collect information, and submit approvals in near real-time.

Revenue Cycle Management

Once the patient is seen, the Revenue Cycle Management (RCM) process starts where the information already collected is coupled with the visit-specific coding and billing information and submitted for payment.

  1. Maximize Reimbursement with Expert Coding and Billing — Ensuring that the coding and billing for each visit are authenticated and processed is critical to maximizing reimbursement. Consider a third-party partner with certified coders and billers that will bring clarity to the process and dollars to the bottom line. A big plus — with a trusted partner, your organization is no longer responsible for maintaining the educational needs required for coding specialists.
  2. Optimizing the AR and the Claims Denial Process — A major component of the AR is identifying issues with the denied claims, fixing them, and then resubmitting them to insurance for payment. By optimizing the denials management process using state-of-the-art technology, including artificial intelligence (AI) with experienced billing and coding specialists, you can manage the rejected claims that are often never worked or resubmitted.
  3. Managing the Collections Process with Finesse — With a robust program to collect patient portions due upfront, the collections process is minimized. However, for various reasons, there will be amounts that inevitably land in the collections category. If the education was performed well initially, patients will understand the expectation to pay at the end of the process.
  4. Discovering Undisclosed Medical Insurance Coverage — The last category, once everything has been paid, will be the uncollectible or charitable write-offs, but what if there were an AI-enhanced system that could scour insurance clearinghouses for undisclosed coverage? Once identified, the claims could be resubmitted as long as they fall within the timely filing requirements. For example, Infinx recently completed an insurance discovery project for a long-time client and recognized a discovery rate of over 25% on uncollectible claims that would have been written off entirely.

We’ve touched on operational aspects of patient access and the revenue cycle to identify where technology and innovation can improve the patient’s experience and overall healthcare operations performance. By meeting today’s challenge to address the patient’s experience proactively, the residual benefits include reduced administrative rework and increased reimbursement over the long term.

Contact us to take a more in-depth look at Infinx’s automated solutions and tech-enabled processes to address the inefficiencies in healthcare operations.