Recently we had the privilege to interview a registrar at a community hospital about her daily patient access routines. This is the first post in a series where we will explore how she uses Revenue Cycle Management (RCM) tools in her everyday work. We will also identify potential gaps in the registration process that could be remedied with integrated revenue cycle software solutions.
It was a busy day in the registration department at a community hospital, and Amanda, a patient access staff member, was registering one patient after another. Working on only one cup of coffee she was feeling a bit drained and slightly overwhelmed with the steady stream of patients for the morning – her mind was scattered and she was having a difficult time focusing on the task at hand.
Registering a Patient
A young pregnant woman presented at Amanda’s desk and told her she did not have insurance or any idea how she would pay for services. If Amanda was feeling unmotivated at this point in her day, without proper guidance the patient could have easily moved on to the point of care without confirming insurance coverage to help pay for the visit.
Amanda entered the young patient’s name and date of birth into the hospital’s registration system and brought up her records from previous visits. There Amanda discovered that the patient may still be eligible for coverage under her dad’s insurance plan. Once she identified the insurance carrier, she then referenced a large manual that contains insurance information and another directory that lists employers and the type of coverage they provide for employees (in this case the patient’s father). This task of manually researching insurance information is time-consuming and can potentially lead to errors in identifying potential insurance coverage.
After she identified the right insurance, Amanda opened her web browser to verify the patient was actually covered. She re-entered the subscriber and patient insurance information on the eligibility website, and confirmed the patient had current insurance coverage with the payer. Once Amanda entered and confirmed the patient’s father’s insurance information, she then moved onto checking the Medicaid coverage status of the patient. Again, she opened her web browser, re-entered the patient’s information into Medicaid eligibility website and within minutes, she discovered the young woman was covered by Medicaid, at which point she updated the registration. The patient felt relieved, as a huge financial burden was lifted off her shoulders, and it made Amanda’s day a little brighter and she felt happy she could find the coverage the patient needed.
By using available RCM tools and following hospital policy, Amanda single-handedly saved the patient and the hospital thousands of dollars – and this move was made on a day her performance wasn’t her best. If Amanda had decided not to try to identify insurance coverage, or if the patient had never been to the facility before, none of this would have been possible during the patient’s visit – good thing she had that cup of coffee!
Even though the outcome was positive, the entire process Amanda went through of searching through manuals and verifying coverage on the internet could have been eliminated with the right RCM software – saving time, increasing productivity and decreasing the possibility of human error.
How To Streamline the Registration Process
Revenue cycle software that integrates directly with the hospitals information system to assist the registration process is available to hospitals nationwide. Healthcare reform has forced all hospitals into using electronic medical records and electronic order entry – why wouldn’t you optimize your registration department to verify insurance coding and insurance eligibility electronically?
Instead of flipping through the lengthy manuals and directories Amanda used to research the insurance information, Revenue360’s Insurance Code Solution automates the decision-making process with on-screen prompts to guide the registrar to select the correct insurance code & sequence. This process greatly reduces user error and claim denials caused by incorrect insurance coding, thus improving productivity in the registration department while also decreasing accounts receivable days.
RCM Software is Key to Revenue Leakage Prevention
Every single day in the United States, patients enter the hospital setting with no knowledge of their insurance coverage, and are registered as Self-Pay. Unfortunately, without confirming insurance coverage many of these accounts are left unpaid and are eventually written off as bad debt for a variety of reasons, including the high costs of medical services. By implementing of revenue cycle technology to automatically confirm insurance eligibility hospitals can greatly reduce the number of self-pay accounts, by identifying Medicaid or other insurance coverage – just as Amanda did for this patient. Patients who are not currently covered by insurance can then be immediately assessed to see if they are eligible for Medicaid or Charitycare to help pay for their visit.
Hospitals need to re-assess the importance of their patient access staff, who arguably hold the most complex job in healthcare.
“They need to do it all FAST and with a SMILE as they communicate with stressed out, sometimes irate, patients demanding immediate attention with the full expectation that all their questions will be promptly, and correctly, answered in the patient friendly terms dictated by hospital policy.”
In addition to salary and benefits, providing the right tools and training make all the difference in successful patient access teams. We will continue to explore the other obstacles Amanda faces in patient access on a daily basis and how RCM tools like Revenue360 can be implemented to make her job easier.