We read a lot these days about how the Covid-19 pandemic has impacted US health systems and physician organizations. While the phrase “the new normal” seems to have become part of our daily vernacular, it’s still yet to be defined for healthcare. What will healthcare delivery look like after the pandemic has finally ended? Will telehealth continue to be a regular method of providing care to patients who prefer it? How will elective and inpatient volume trend in the next 3, 6, 12, 18 months and beyond as our nation continues to navigate the pandemic? What does the healthcare experience look like for patients who’ve lost jobs and insurance?
While we can speculate about these questions, we won’t likely know the answers for some time. So how do we forge a financially stable path forward with so many unknowns surrounding the revenue cycle? For that question, there isan answer. It begins with the patient and ends with a stronger bottom line. The fastest way to build a revenue cycle for the future is by partnering with revenue cycle experts who have the tools of tomorrow’s revenue cycle already in place. With this approach, health systems and physician organizations can achieve their strategic revenue goals faster and with fewer resources, all while ensuring an enhanced patient experience.
Criteria for Identifying Vendor Partnerships to Strengthen Operational Gaps
When choosing a revenue cycle partner, don’t settle for the status quo. Look for a forward-thinking partner with proven success in the following areas.
Patient Registration
Many denials are caused by issues during patient registration, such as missing patient information, insufficient demographic information, or inaccurate insurance information. Choose a partner that understands the importance of implementing proactive measures during patient registration to mitigate denials later and can manage registration virtually. The best partners should have the following capabilities:
- Pre-registration over the phone with bilingual patient access specialists
- Real-time insurance eligibility verification
- Insight into the most current, complete demographic data
- Resolution specialists who understand how to have a conversation about patient financial responsibility
Claims Management
The quality and timeliness of reimbursement is closely aligned with the quality and timeliness of claims submission. Failing to meet filing deadlines or to include necessary documentation can mean increased rejections and denials, decreased cash flow, and delayed reimbursement. The revenue cycle of the future has no place for outdated, manual claims management processes. Look for a partner that uses the latest technology to ensure the cleanest claims and the most efficient claim submission process. They should have expertise in the following areas:
- Advanced Claim Scrubbing Technology. Issues at the point of submission are like cogs in the revenue cycle. Be sure to choose a partner with the most advanced technology that can identify issues before the claim hits the payer’s adjudication system. This gives staff the opportunity to correct claims and resubmit, avoiding rejections and delayed reimbursement.
- All-Claim Expertise. Look for a team that has extensive knowledge of the requirements for primary, secondary, and third-party liability payers. This should include governmental, managed care, and commercial payers, as well as VA, workers’ compensation, and motor vehicle accident claims.
- Patient Accounting Systems. The most experienced partners will be those with vast knowledge of legacy and industry leading patient accounting systems.
Denial Analytics
The revenue cycle of the future will be one that uses denial analytics to identify problematic trends and opportunities for improvement before they impact the bottom line. While retrospective analytics are a good place to begin, the analytic solution you trust must be continuous and available in real time so action can be taken to correct issues proactively. Following are key elements of an effective analytics strategy.
- Denial Analysis. The best partners will perform an initial detailed analysis of at least 12 months of claims data and provide a summary that includes process improvement guidance. The analysis should include:
- Business intelligence by denial type, including payer, location, bill type, and more
- Insight into revenue trends across all payers, locations, and types
- Root cause analysis and decision support for denial prevention
- Denial Management. Payer denials are one of the biggest opportunities for revenue improvement as 90% are avoidable.[1] That’s revenue left uncollected unnecessarily. While many providers may see denials as a permanent part of the revenue cycle, they can be minimal part of the revenue cycle of the future. Look for a partner that focuses on denied claims based on their preventability, collectability, and overturn success rate, which should include::
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- Managing payer website automated claim status
- Denial qualification using payer claim status and adjustment group and reason codes
- Denial categorization
- Denial reporting to measure and manage denials
- Integrated artificial intelligence to drive assignment, follow-up, and resolution
Patient-Centric Self-Pay Collections. Recent research by Eliciting Insights found that 84% of hospitals have experienced a reduction in patient collections since the beginning of the pandemic.[2] This is no doubt due to the millions who have lost jobs or had a reduction in hours during the pandemic – impacting their employer-sponsored health insurance. When patients are worried about paying utility bills or keeping food on the table, your healthcare bill takes a back seat. Even after the pandemic, the economic fallout and financial pressures on patients could linger for years to come.
Before the pandemic, 97% of hospitals said they send non-pay accounts to bad debt collections.[3] Another 47% of hospitals said they garnish wages or put liens on a patient’s property to collect on unpaid bills and 42% said they notify credit agencies, which could be devastating for patients, especially now.
The revenue cycle of the future doesn’t treat patients in a one-size-fits-all collection process designed around the workflows of the health system or physician organization. Instead, it looks at each patient’s unique circumstances and then gives options that work for the patient. Elements of a patient-centric payment process to look for include:
- Adaptable. A patient’s financial situation changes over time and options for paying healthcare bills should be adaptable to any situation. Look for a revenue cycle partner that uses technology to identify a patient’s propensity and ability to pay at the time of registration. The partner should also have the ability to identify the need for financial assistance and to help patients through that process.
- Flexible. In the past, each service provided was considered a separate event and was billed as such. That meant that, for a family of four, there could be dozens of outstanding healthcare bills, making it difficult to prioritize and pay them all. A better approach is to allow guarantors to roll up charges—current and future—into a single account, including charges from multiple family members. This reduces frustration for the family and makes it easier to budget for their healthcare needs.
- Payment Plans. Sending invoice after invoice demanding payment in full is a waste of time and resources when the patient isn’t able to pay. Choose a partner that offers payment plans based on the patient’s financial situation. This makes it easier for patients to pay and reduces bad debt write-offs. It also ensures patients can afford the care they need when they need it, which impacts patient satisfaction and outcomes.
- Payment Options. An article published by Medical Economics states that “68 percent of consumers would prefer to pay their medical bills electronically, and 92 percent want to know what their patient responsibility is in advance of service.”[4] The best revenue cycle partners have the technology to accommodate both these preferences. Offering an easy to use payment portal with mobile access, as well as self-select payment options and payment estimations, creates a more patient-centric financial experience that makes it easier for you to get paid.
- Engagement and Customer Service. Every patient financial engagement is a reflection of your organization’s brand. Look for a partner that offers a full-service contact center with both live calls and IVR technology that are configured for a patient-friendly experience designed to encourage payment. They should also offer and manage digital outreach through email or text, depending on the patient’s communication preferences. As a part of their service, they should be able to design easy to understand statements and manage printing and mailing.
Revenue Cycle for the Future
The revenue cycle of the future will continue to evolve to reduce costly, labor-intensive processes and the inefficient workflows of today’s revenue cycle. Fortunately, you don’t have to wait until the future because it’s already here. By partnering with revenue cycle experts, you reap all the financial benefits without needing to invest in expensive technology, manage additional resources, or reallocate IT staff to manage extensive implementations. Choosing the right partner is essential to achieving a positive return on your investment. Following the guidelines above can help you make the right decision so you can achieve your revenue goals in an efficient and effective manner.
[1] https://www.fiercehealthcare.com/payer/waystar-90-claim-denials-are-avoidable-help-technology
[2] Effective Strategies for Patient Collections, iVita Financial, October 1, 2020
[3] ibid.
[4] https://www.medicaleconomics.com/view/benefit-flexible-patient-payment-options
