As we near the last quarter of 2020, the healthcare system has gone through shock waves from the COVID-19 pandemic, not the least of which is the financial tsunami with its inconsistent revenue streams and increases in patient responsibilities. The healthcare industry has been faced with monumental changes and has adapted at an earth-shattering pace.

From increased emergent care to the canceling and rescheduling of voluntary procedures to the foundational changes brought by telehealth, healthcare participants have to speed ahead at a pace not seen before. But are we sacrificing revenue for efficiency? Healthcare providers, often using manual systems, are trying to keep pace and respond to the changing payer and governmental requirements at the possible expense of operational performance.

Are Overall Collections at Risk?

In a new industry report released by InstaMed, a JP Morgan Company, the 10th annual report documents a growing consumer demand for electronic healthcare payments whether inpatient, outpatient, or emergency care. Consumers are tech-savvy and want to access the health information and pay their portion due through electronic means.

Diametrically opposed, about 88 percent of providers reported using paper-based or manual transactions to often collect patient financial responsibility after the care had been rendered. Even with viable electronic options available, providers are still leveraging manual or hand-written processes for everything from patient check-in to collecting patient portions due.

Of the providers who responded to the InstaMed survey, the increases to overall patient financial responsibility ranked at the top of their concerns, followed by ways to increase revenue and cash flow, the increases they have been experiencing in bad debt, and their growing days’ outstanding figures. About 65% of providers in the report have seen an increase in patient financial responsibility in the last year.

Leveraging Data to Maximize Collections

Technology and automation allow us to present more accurate and timely information to facilitate the patient’s financial contribution. It’s more important than ever that the business staff responsible for onboarding patients are equipped with the most accurate data, and that patient portions are collected upfront.

First Step – Insurance Verification

The first step in this process is securing accurate and valid insurance and demographic information about the patient. By utilizing a transparent insurance verification and benefits eligibility automation package, healthcare providers can track and confirm precise patient coverage details in real-time while avoiding later denials due to ineligibility.

Utilizing a seamless integration or portal, front office, and scheduling staff would be able to access an extensive payer clearinghouse to determine:

  • the patient’s eligibility and dates of coverage,
  • the primary or secondary insurance relationship
  • co-pay and/or co-insurance due,
  • annual deductible met and remaining, and
  • any out-of-pocket maximums.

Next, Collecting Patient Portions Due

Once the insurance information is determined, it is critical for overall practice financial health that all estimated patient portions due are collected before the time of service, if possible. Today’s consumer is conditioned to pay before receiving goods or services. Still, it is often the practice that neglects to ask for payment until the patient arrives or even after insurance has paid.

With strong, well-defined financial policies in place, expert collections training for staff, and clear-cut automated estimates available, patient portions collected before the time of service no longer have to slowly wind their way to either payment (often several months post-visit) or collections. Additionally, giving patients automated payment options greatly increases payments – patient portals, apps, email notification, etc.

Last, Prior Authorizations

By automating your prior authorization process through an Artificial Intelligence (AI) driven software solution, most approvals can be obtained in real-time. Utilizing an HL7-level interface with insurance payers, prior authorizations can be automatically initiated, tracked, followed-up, and resubmitted (if necessary) without human intervention in most cases.

What once took several hours to several weeks manually can now be accomplished in minutes (or seconds), and unusual outliers can be followed expertly by specialists.

According to the latest CAQH Index, prior authorizations are only performed by automation in about 13% of healthcare practices. This means a great number of practices are spending unnecessary time and resources, not to mention patient frustration, managing a burdensome and redundant system leading to denials, and lost revenue.

In Summary

All things being equal, it seems there is no trade-off in the revenue cycle. Streamlining the entire front-end patient access process brings improvements to not only your bottom line but also to your patients’ experience. Their experience improves when they know and understand both your financial policies and their obligations while having the ability to access electronic payment avenues easily.

Contact us to schedule a demo of our complete, end-to-end Prior Authorization Software solution and improve your overall patient collections function.