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● Revenue Cycle Management

Great patient care begins at

By Blair Baker D

octors may get the lion’s share of credit for helping patients, but everyone – including patient access staff – is responsible for quality care. T ese key employees provide registration,

scheduling, outpatient pre-certifi cation and hospital switch- board services, and are usually a patient’s fi rst introduction to the organization. Hospitals that equip patient access staff with eff ective 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. Health- care organizations looking for a healthy balance between high levels of customer service and effi cient collections must fi rst overcome specifi c patient-access challenges. First, hospitals must streamline their registration ac- tivities while simultaneously collecting enough of the right information to ensure they generate the appropriate revenue from the patient. T is begins with solutions that facilitate comprehensive patient eligibility and benefi ts verifi cation checks. With access to benefi t, referral and pre-certifi cation information, patient-access staff can quickly verify the extent of an individual’s coverage and determine fi nancial liability in the form of co-pay and/or deductible. Software applications should have the ability to auto- matically initiate searches that systematically exhaust all available criteria, reducing the need for repeated searches, yet be fl exible 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. T ey 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 translate into fewer registration errors and more accurate billing.

Armed with patient eligibility and benefits data, staff can then begin a fi nancial “triage,” which provides

insight into how the account will ultimately be settled. Utilizing a combination of provider contract rates and current patient-specifi c benefi ts 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. T e net result from more accurate and timely information about patient collectible amounts is increased revenue col- lection, decreased A/R days and reduced patient bad debt. Likewise, an additional benefi t in communicating patient responsibility up front is that the streamlined process yields higher patient satisfaction. Of course, many patients neither have the fi nancial 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 tech- nologies 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. Benefi ts verifi cation, patient responsibility estimation and assistance program eligibility and enrollment activities initiated during registration not only highlight a health- care organization’s commitment to accurate and thorough revenue management, but also its dedication to providing the highest possible levels of patient care and customer satisfaction.


registration But collecting initial information is just the beginning in the integrated revenue management cycle.

Blair Baker is a certified patient accounts manager and director of provider product development, Emdeon. For more on Emdeon: 304ht-209

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