Patient access is truly the front line of defense hospitals have against bad debt and unpaid collections. Rather than spending countless hours sorting claims submissions and working through claims denials, by strengthening your hospitals’ patient access process, you tighten up the gaps that allow revenue leakage, thus improving your bottom line.
But how do you enhance patient access, also known as the registration process? We speak with an industry expert on revenue cycle management software and get his input on the best way to reduce bad debt and claims denials.
The urgency and goals are clear. Decrease medical claims denials and write-offs with intelligent-guidance software that is programmed to prompt the input of medical necessity data and information at key points during the patient registration process. Hospital revenue cycle teams need to take the guesswork out of patient access systems and collect more revenue by improving clean claims rate.
Hospital Registration: A Necessary Nuisance for Patients
A hospital registration process is a key step needed in order to provide services to patients and collect the correct financial compensation and payment. Yet often, from the patient’s perspective, the entire registration process is nothing more than a cumbersome waste of time. In an ideal world, the patient would simply walk into the hospital and go straight to their doctor or specialty office to have services done without waiting in line and filling out paperwork first.
However, it does not work that way. Hospital registration is an unavoidable and necessary process. What are the responsibilities of the hospital patient access department? According to the National Association of Healthcare Access Management (NAHAM), typical patient access responsibilities include:
- Pre-admission services
- Customer service
- Patient identification
- Gather family and patient information
- Identify special needs
- Insurance pre-certification
- Confirm the type of care services
- Collect signatures and deliver all required documentation
- Gather accurate and complete patient information
- Collect point-of-service payments
Making First Impressions Count with a Streamlined Registration Process
The registration process is the patient’s first encounter with a healthcare facility, so it’s important to make impressions count. Furthermore, the Hippocratic oath still applies, and it’s important to “do no harm” to the patient. Lengthy waits and frustrating processes can add discomfort for patients that are already potentially in pain or uncomfortable in the first place.
Effective streamlining and optimization of the patient access operations of a hospital can help maximize resources and deliver higher quality service to patients who gain and perceive more value. Approaching the process holistically creates a smoother flow by using a variety of tools and solutions, such as:
- Utilization of revenue cycle experts to improve overall performance through identification of weak points
- Implementation of revenue cycle management software that is tailored to the specific needs of your healthcare organization
- Continuous patient access staff education, updates, and training to improve workforce skills
- Advocate for patients that may have barriers to support or face other financial challenges
- Going beyond the front desk and involve revenue cycle managers in the ambulatory and care coordination side of services in order to meet special patient requests
Software for Patient Access Management Simplifies Registration
Robust patient access software is an effective way to simplify the sometimes complicated registration process. With the SSI Group’s advanced solutions for patient access, registration staff are literally guided through the entire patient registration and prompted to ask for upfront payments and other critical information, such as medical necessity data, insurance carrier information, etc.
Automation of the all of the information collection steps along with the guided input of insurance information and other important pieces of patient financial information unlocks a world of opportunity for hospitals to improve their healthcare access management. Being able to view insurance benefits information in real-time and input accurate medical necessity codes helps reduce claims denials and improve the accuracy of patient registration.
Technology is a vital component in order to provide patients with accurate pricing estimations, which are now required by law in many states. Staff members also have the opportunity to identify barriers to financial support for care, which can often be remedied with patient eligibility software to help a patient obtain Charity programs and Medicaid payments.
Becoming the Patient Advocate
Nick Davis, the SSI Group’s VP for Access Product Management, explains that the best way for hospitals to decrease bad debt and improve hospital revenue cycle management is by “becoming the patient advocate.” With more than 14 years of experience developing and working with patient access software, Davis is familiar with the challenges hospitals face when trying to secure revenue leakage and optimize their revenue cycle. Through first-hand experience, Nick has found that providing tools and training registration staff to act as advocates on behalf of the patients is an ideal process solution:
“When patient access assumes the role of patient advocates, everybody comes out ahead. Patients are more informed and can take in a deep breath and let out a sigh of relief. They can relax, knowing what they will owe and that they can afford care, whether by qualifying for a charity program or setting up a convenient payment plan. Especially in states that expanded Medicaid, quite frequently patients come in thinking they are uninsured then literally drop their jaws in shock to find out they qualify for assistance, notably Medicaid which usually pays in full. When acting as the patient advocate, the hospital also comes out ahead because they experience an increase in revenue and a decrease in bad debt.”
The following lists show the breakdown of moving components in a smart patient access process that make this type of synergy a reality in real-time:
- Prepare patient for the financial responsibility
- Empower patient with information necessary to be engaged as a consumer of healthcare
- Identify mutually agreeable payment terms
- Prevent the patient’s account from ending up in a bad debt status
Implementing a Process:
- Allows patient access to act as advocates on behalf of the patients
- Explains insurance benefits to patient
- Communicates amount patient can reasonably be expected to be responsible for
- Identifies needs and connects patients to various resources for assistance (i.e. Charity care, Medicaid, co-pay assistance programs)
- Allows patient to make decisions and prepare for costs related to medical care
- Comprehensive scheduling system
- Real-time eligibility
- Cost of care estimate capability
- Medical necessity check
- Yes/No Authorization Database
- Payment processing
- Patient Financial Analysis
- Call and screen recording
- Call Queue monitoring system