Blog has been updated from November 2018
The role of patient access encompasses a variety of critical responsibilities within the healthcare payment lifecycle. To be successful, all healthcare organizations must focus on the complete patient experience – from the moment an appointment is scheduled, until the final bill is resolved. Patient access holds the key to achieving a profitable revenue cycle.
Whether a hospital system, a provider practice, or an ancillary services practice, there are similar steps that must be negotiated and that can negatively affect revenue resulting in rejected claims or denials from payers. Meaningful advances in prior authorization and insurance verification management necessitate that organizations adopt best practices across all patient access departments ensuring the integrity of the registration data collected.
How Patients’ Initial Contact Can Smooth the Way for Revenue Cycle Success
When patients present for treatment, whether that initial contact is by phone, referral, or walk-in, the requirements are the same to ensure success in meeting third-party payer requirements and securing payment for services rendered. The top three areas to focus on include the following:
1. Insurance Verification and Benefits
The initial opportunity to impact the healthcare payment lifecycle is when first collecting a patient’s insurance information. While it’s commonly agreed that it is imperative to verify this information, ascertain what benefits are covered, and get an estimate on what deductibles and co-insurance amounts remain, the process for accomplishing this is antiquated and frustratingly time-consuming.
Capturing revenue is inherent in having the most up-to-date and current benefit information possible for your patients. The most efficient way to accomplish this is through a strong automated solution that integrates seamlessly between your organization and a vast network of payer databases to provide insurance verification and benefits in real-time.
2. Prior Authorizations
Next, the prior authorization (PA) process has been maligned as overly burdensome, time-consuming, and unnecessarily complex. While there is movement industry-wide in trying to simplify and streamline the process, best practices today are addressing these issues head-on and include automating the PA function through artificial intelligence (AI) supported software solutions that leverage automation with exception handling by certified specialists.
Using a powerful Prior Authorization Software system to help with the PA process is critical to preventing denials and maximizing your cash flow. Such a system would determine the necessity of PAs, submit PAs directly to payers, follow up or appeal as required, and then notify the scheduling department upon approval in real-time. Not only would this ensure revenue capture and denials reduction, but also shift the employee time to direct patient care and experience.
3. Determining or Estimating a Patient’s Portion Due and Collecting
The last leg of this triad involves patient pay estimation. Once insurance benefits are verified and all PAs are approved, patients are scheduled for care. At this point, it is critical that your patient access process includes determining what portion of the ultimate amount due will be the patient’s responsibility and then collecting that amount prior to the visit/procedure/test.
With the growing popularity of high-deductible health plans, your patients may be responsible for over 30% of their charges and up to 90% of patients are willing to pay prior to seeing their physician or receiving tests or care if given an explanation and a simple way to pay. Take advantage of this by automating the estimation process and implementing strong training and guidelines for front line employees responsible for the collection.
Providing real-time information not only increases your patient’s understanding of their responsibility but also improves your overall patient satisfaction with their experience. The cost savings and ROI on these types of technology upgrades are significantly larger than pursuing traditional revenue reduction plans and are proven to increase patient satisfaction.
Schedule a demo to see how you can fully automate your patient access workflow with Infinx’s patient access solutions.