How Anderson Regional Revamped the Patient Financial Experience Amid the Pandemic

 

Last year, with the price transparency rule deadline looming, one Mississippi medical center made a bold move to integrate its patient access and patient financial clearance processes to provide greater continuity in financial care.

It’s a move that was made more challenging by COVID-19, when many revenue cycle staff shifted to remote work and many patients remained apprehensive about reentering a medical environment, limiting opportunities for in-person financial counseling.

“As we prepared for price transparency compliance this past fall, we believed there was an opportunity to truly integrate estimation, collections and eligibility with our claim submission and clearinghouse procession,” says Kevin Adams, director of revenue cycle services for Anderson Regional Health System, a two-hospital system in eastern Mississippi.

“By creating a seamless connection between demographic validation, insurance verification and patient estimation on the front end through adjudication of the claim on the back end, we could deliver a better patient financial experience while driving stronger revenue cycle results,” he says.

 

How Anderson Regional Did It

Patient access is a patient’s first impression of a health system. It’s where registration and the first components of the billing process occur. The quality of the patient access experience—including financial estimation—is a critical predictor of whether patients will seek care. It’s one reason why healthcare revenue cycle teams are investing in tools that enhance efficiency while improving the patient financial experience, according to the Healthcare Financial Management Association.

Expectations for patient access performance are high: Registrars must be fast and accurate, navigating patients’ financial questions and concerns while establishing expectations for payment—and collecting money upfront. With 39% of hospitals expected to record negative operating margins in 2021, organizations must have the right tools to deliver on patient expectations for transparency and financial communications.

Prior to the fall of 2020, Anderson Regional had worked with a vendor for estimation, collections and eligibility. But with the price transparency rule set to take effect in January 2021, revenue cycle leaders knew the health system would need to bolster its financial estimation capabilities to meet one of the rule’s key components: posting charges for 300 shoppable services online in a searchable, consumer-friendly format, like an online price estimation tool.

“Given the magnitude of this effort, taking the time to evaluate ways that our system could go beyond the regulatory requirements to truly deliver an integrated patient financial experience from the front end to the back made sense, especially in an era when a greater proportion of healthcare costs are being passed to the consumer,” Adams says. However, leaders knew this task wouldn’t be easy: “It was definitely a more challenging initiative for our team and a vendor’s team than it would have been in a normal business environment—one where COVID-19 did not exist,” he says.

Anderson Regional was surprised to learn it could transform its approach with the help of a long-term revenue cycle partner that the system knew and trusted: The SSI Group.

Front-end solutions for supercharging healthcare revenue cycle performance are one of The SSI Group’s best-kept secrets. Anderson Regional has already collaborated with The SSI Group on back-end revenue cycle initiatives. Its work with The SSI Group in revamping the system’s denials management program resulted in a 92 percent reduction in Oncology denials and a $1-million-dollar reduction in overall denials. Now, revenue cycle leaders considered: Could the same partnership that fueled gains in performance for back-end revenue cycle functions also elevate the system’s approach to patient access?

Anderson decided to integrate Access Director, The SSI Group’s suite of access management tools, with its existing revenue cycle management platform. “With SSI’s Access Director, healthcare organizations can build the package that best suits their needs,” says David Mistkawi, vice president, access management solutions for The SSI Group. “Access Director relieves the burden of complicated registration and collections processes, enabling front-line staff to focus on patients instead of policies. Across clients, Access Director reduces registration errors, optimizes collections and stops revenue leakage before it starts. Just as important, it automates the process of delivering accurate financial estimates to patients, increasing financial engagement and dialogue.”

Functionality for this comprehensive patient access management solution comprises:

  • Address Validation
  • ID Validation
  • Eligibility
  • Medical Necessity
  • Admission Notification
  • Estimation
  • Financial Clearance
  • Patient Payments

Anderson Regional worked with The SSI Group in the fall of 2020 to implement the tool, adopting Access Director’s full suite of patient access functionality—from eligibility to medical necessity, patient data validation and patient payments — and augmenting its existing eligibility and admission notification tools with solutions from The SSI Group. During the implementation process, Anderson Regional met with staff to explain why the tool was needed and how it could address consumers’ desire for greater transparency around costs of care while bolstering employees’ efforts to engage patients in paying their bill.

“Getting staff comfortable with the tool was the most important piece,” Adams says. “One aspect of the tool that appealed to staff is the ability to provide price estimations internally, at the point of contact, and externally—via our website—for both commercial and self-pay patients. By looking up the shoppable services we offer, consumers can not only see the list price for these services, but also gain an accurate estimate based on their insurance plan and the amount of their deductible met to date. It’s a service that ensures consumers are highly informed at each stage of the care decision-making process.”

One aspect of Access Director that has proved especially appealing is the level of specificity it offers. “It actually gathers information on the types of supplies used for a procedure so that estimates reflect the total cost of care, not just a charge based on the CPT code for the procedure itself,” Adams says. “This gives patients a more accurate estimate of the services that will be provided for them.”

 

A Seamless Approach to Transparency and Engagement

Anderson Regional’s revamped approach to patient access services went live on Jan. 1, 2021, the day the price transparency rule took effect. Since then, Anderson Regional has generated 9,820 estimates in using The SSI Group’s estimation tool through July 2021. These estimates represent $2.7 million in patient financial responsibility and total estimated reimbursement of $13.3 million. Further, patients have relied on Anderson Regional’s Online Patient Estimation Portal to generate 145 online patient estimates.

“Patients actually come to us with their estimate in hand, saying, ‘Here’s my estimate for this particular service,’” Adams says. “We can then look up the ID number associated with the estimate to ensure patients have correctly entered details regarding their plan of care. It’s enormously useful for both consumers and our staff.”

Access to the right information also supports patient collection efforts. From November 2020 through July 2021, Anderson Regional processed 4,784 successful payments via SSI Patient Payments, with more than $653,000 collected. “I remember talking with a group of physicians several years ago about our plans to move forward with a cost estimation tool to support our patient payment efforts, and they frowned at the idea of asking patients for their cost share of the insurance balances. Two or three months after go-live, many of their practices began to collect payment in advance from patients, too, based on our success as a system,” Adams says.

Most of all, Adams is pleased with the ability to leverage Access Director to establish a consistent, tightly integrated approach to patient access across the system. “Now that we have one vendor that handles the entire process for us, we’re able to leverage information such as remittance data to provide a more holistic view for patients around their financial obligation,” he says. “We’re very pleased with the way in which The SSI Group’s Access Director solution suite prepared us not only to meet regulatory requirements around price transparency but also enhance the patient financial experience.”

For more information about The SSI Group’s Access Director solution, contact David Mistkawi, Vice President, Access Management Solutions, The SSI Group (david.mistkawi@ssigroup.com).

Contact us to learn more about how The SSI Group can support you and your organization’s claims management processes.