Patient access management as a revenue driver

Patient Access Revenue Driver April, 2014

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Patient Access Management is the First-Step towards Successful Revenue Cycle Management Post-implementation of ACA (Accountable Care Act), many healthcare providers are concerned about its impact to their revenue, mainly due to the potential millions of uninsured Americans that will begin to receive new healthcare coverage. As more people become eligible to receive healthcare services, and millions of potential patient payments transactions being added to the healthcare system, the difficulties providers face with patient collections is becoming a top priority. Tackling bad debt is an ongoing challenge for providers. In the third quarter of 2013, the national average for hospitals bad debt was pegged at 3.31%: 2.13% for charity and 5.44% for total uncollectable accounts, according to ACA International1. Additionally, an analysis from Citi estimates that hospital bad debt could reach USD200 Bn by 20192.

For example, the two-hospital Singing River Health System, which serves Pascagoula and Ocean Springs in Mississippi, had an uncollected combined patient debt of USD88 Mn, for 2012 and 2013.

There are growing instances of providers being impacted by bad debts, largely due to accumulation of unpaid bills and the write-offs due to the soft economy, and deterioration of insurance coverage.

“The hospital is facing extreme need across the board and bad debt has climbed in five years from about USD40,000 to USD1.2 Mn” – McKenzie County Healthcare Systems, CEO Dan Kelly3.

“Bad debt is in the “millions” of dollars and the inability to locate patients continues to be a significant burden” – Mercy Medical Center, CEO Matt Grimshaw3.

However, improved revenue cycle performance through process improvements to reduce bad debts and denials can account for 2-4% of additional net patient revenue4, a small percentage that can translate into substantial revenue for an average hospital. Although many providers are still relying on the traditional work flow of pursuing revenue by billing patients post treatment, some hospitals are taking a more efficient approach by calling patients in advance of treatment services to manage scheduling and pre-registration, using IT tools to assess their ability to pay, including insurance verification, and helping patients with payment options and financial counseling when necessary.

Patient Access Management Patient access is a critical work flow within the revenue cycle management (RCM). For successful patient access management, providers need knowledgeable and competent professionals to do an efficient job. Additionally, the staff needs to be supported by the right patient access tools and processes to successfully manage patients during the initial stages of the RCM lifecycle.

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The Association of Credit and Credit Collections (ACA International): The Hospital Accounts Report Analysis on Third Quarter 2013 Modern Healthcare: Targeting bad debt, August 17 2013 Williston Herald: Hospitals facing possible crisis due to bad debt, November 30 2012 5 Healthcare Finance News: Stopping the rise in hospital bad debt, November 2013 2 3

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Patient access professionals must be able to perform a number of complex tasks, including reviewing referrals, scheduling appointments, verifying eligibility, obtaining authorizations, and collecting preservice payment at the time of service.

Patient Access Key Processes

Scheduling patient visits and pre-registration is a labor intensive task. Calling patients and referral physician offices and other care providers to collect information and address missing documentation takes time and utilizes precious staff resources. Incomplete patient records can not only delay care but also affect revenue collection. Also, prior to the appointment with the hospital, it is necessary to verify a patient’s insurance benefits and coverage for respective medical procedures. Insurance verification and pre-authorizations are critical processes for health providers. Absence of proper eligibility can lead to several problems such as delayed payments, claim resubmissions, patient dissatisfaction, and nonpayment.

Key Challenges Some of the key challenges facing organizations in their patient access management are primarily lack of technical knowledge and trained patient access professionals, high turnover of staff, inefficient patient audit and monitoring processes, lack of system integration, and lack of best practices to optimally drive patient access management.

Scheduling & Pre-registration As soon as a patient contacts an organization, it sets into motion a series of processes for the scheduling and registration team. The team needs to be ready and competent to be able to deal with all questions from the patient at this point. Thanks to consumerism, patients today have become increasingly informed and aware of their rights, and the new healthcare law enables them to the rights and information available from providers. Hence, it is critical to have a competent staff with thorough understanding of the HITECH provisions to be able to answer patient queries and provide proper disclosures. Additionally, providers need to have efficient processes and tools in place to facilitate accurate pre-registration by soliciting correct patient information and timely inputs in the system.

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Insurance Verification & Pre-Authorization Complex eligibility requirements, transition to HIPAA 5010 and new ICD-10 coding procedures, and lack of specialized staff can affect verification and preauthorization processes. While it is critical to have correct processes in place for transition to HIPAA 5010, which also deals with how electronic eligibility checking is done, it is also important to have a competent staff with thorough understanding of the ICD10 procedures to be able to properly determine what is required for a preauthorization.

Patient Access Management Best Practices Highlights

Hospitals need to focus on patient access management to successfully drive their revenue cycle strategy.

Patient access management requires not only a trained and competent workforce but also efficient processes that enable hospitals to identify patient access pitfalls and tools to successfully minimize revenue loss.

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