But collecting initial information is just the beginning in the integrated revenue management cycle.
Doctors may get the lion’s share of credit for helping patients, but everyone – including patient access staff – is responsible for quality care.
These key employees provide registration, scheduling, outpatient pre-certification and hospital switchboard services, and are usually a patient’s first introduction to the organization. Hospitals that equip patient access staff with effective processes and technologies are initiating the greatest patient experience possible.
But quality patient care, in turn, depends on hospitals being paid what they are owed for services rendered. Healthcare organizations looking for a healthy balance between high levels of customer service and efficient collections must first overcome specific patient access challenges.
First, hospitals must streamline their registration activities while simultaneously collecting enough of the right information to ensure they generate the appropriate revenue from the patient. This begins with solutions that facilitate comprehensive patient eligibility and benefits verification checks. With access to benefit, referral and pre-certification information, patient access staff can quickly verify the extent of an individual’s coverage and determine financial liability in the form of co-pay and/or deductible.
Software applications should have the ability to automatically initiate searches that systematically exhaust all available criteria, reducing the need for repeated searches, yet be flexible enough to be used according to industry best practices verifying in both batch and real-time formats as well as leveraging data from payer websites. They should also facilitate condensed payer responses that highlight the most important eligibility data, providing a quick reference for patient access staff. In the end, personnel will perform fewer keystrokes, which translates into fewer registration errors and more accurate billing.
Armed with patient eligibility and benefits data, staff can then begin a financial “triage,” which provides insight into how the account will ultimately be settled. Utilizing a combination of provider contract rates and current patient-specific benefits information, advanced technologies can provide estimates of patients' out-of-pocket expenses, allowing staff to inform them of their expected costs. Employees can then collect or hold funds during scheduling, registration, at the time of service or at check-out.
Patient responsibility estimation tools not only provide individuals with more information about the true cost of their care, but also establish a baseline so providers know beforehand what they need to collect directly from patients – two key elements that add transparency to the revenue cycle. The net result from more accurate and timely information about patient collectible amounts is increased revenue collection, decreased A/R days and reduced patient bad debt. Likewise, an additional benefit in communicating patient responsibility up front is that the streamlined process yields higher patient satisfaction.
Of course, many patients neither have the financial means nor the insurance to cover their medical expenses. However, a high percentage of these self-pay patients are simply unaware of third-party funding sources that will help cover their bills. Providers must deploy both advanced technologies that can help them determine patient eligibility in programs, including Medicaid or Social Security Disability Insurance (SSDI), as well as personnel resources that can guide eligible patients through the complex application and approval process.
Benefits verification, patient responsibility estimation and assistance program eligibility and enrollment activities initiated during registration not only highlight a healthcare organization’s commitment to accurate and thorough revenue management, but also its dedication to providing the highest levels of patient care and customer satisfaction possible.
About the author
Blair Baker is a certified patient accounts manager and director of provider product development for Emdeon, a leading provider of revenue and payment cycle management solutions, connecting payers, providers and patients in the U.S. healthcare system. Learn more at www.emdeon.com.