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Why Patient Enrollment and Management Must Be Done Right to Improve Patient Satisfaction
The importance of streamlined patient access management is being felt more in the current environment of the healthcare system. Hospitals need to ensure its efficiency to improve their profitability.
Structure of Patient Access Management Department structures for patient access usually vary among hospitals. However, efficient hospitals have the functions of patient access management structured with patient care coordinators whose responsibilities are divided into the following: Pre-service – It helps for hospitals to be aggressive in managing the expectations of the patient prior to rendering non-emergency service. Referrals, authorizations and expected co-payments must be worked out before service is rendered to the patient.
Time of service – A strong pre-registration program plus an improved registration process is important for improving patient flow and getting more accurate financial data of patients. Hospitals employing best practices do have facilitated registration processes in place for pre-registered patients. Here, their insurance coverage plus ability in handling self-pay amounts are determined before they present themselves at the hospital.
Post-service – ED (Emergence Department) services are those that cannot be scheduled beforehand. Significantly, ED volumes have risen as the number of uninsured patients has. To tackle this, efficient hospitals strictly follow a process of insurance verification carried out within 24 hours of the patient’s admission.
The same applies for self-pay accounts. Patients having long stays in the hospital are re-evaluated for ensuring that their eligibility is maintained. These hospitals also make sure that they financially screen a significant number of ED patients before their discharge. All these steps could help reduce the amount of uncollected revenue for hospitals.
This categorization of responsibilities is important since the issues arising at each of these stages are unique and must be dealt with separately in an expert manner. It should also be classified as part of the financial department of the hospital since this does impact various stages of the revenue cycle. All information relating to the revenue cycle is shared among all the revenue cycle team members by efficient hospitals since it is important to identify the patients’ ability to pay as the revenue stream starts. Patients having high-deductible insurance
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governmental policies. Error-free Patient Registration Important Patient registration is such a crucial stage of the profitability of a hospital now, since errors at this stage including inadequate verification of eligibility, inability to secure prior authorization, and mistakes in patient registration could cause claim denials, lesser cash flow and greater chances of bad debt. Some of the stats are alarming – 30% of denial of claims takes place during the first submission while 60% of the denials are not resubmitted. Reworking a claim could cost an average of $25.
Patient Access Data for Revenue Cycle Team The data gathered by patient access staff must be shared with the entire revenue cycle team so that potential collection issues can be identified and assigned to the right people within the cycle. This helps in early detection and resolution of the issues. It makes patient access management an important element in managing issues faced by the hospital including bad debt, denials and patient bed placement. Efficient hospitals actively track denials and look to devise methods for eliminating process deficiencies that cause denials. They also have a regular review of bad debt files. While debate persists on whether bed placement must be transferred to the nursing department of the hospital, it has conventionally been classified under patient access. Securing critical financial information and disseminating it is an important task for patient representatives. To sum up, an efficient patient access management system can improve the ability of the hospital to get paid for its services and reduce the bad debt risk, increase its cash flow, and bring down the pesky costs involved in claim reworking.
About Outsource Strategies International Outsource Strategies International (OSI) is a reputable medical outsourcing solutions provider based in Tulsa, Oklahoma offering advanced medical billing and coding solutions for hospitals, physicians, physicians' groups, clinics and other healthcare entities. Find more details at: www.outsourcestrategies.com.
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