Thanks to the Patient Protection and Affordable Care Act, patient satisfaction has become a metric by which healthcare providers will be judged.
While the clinical side may be curing diseases and saving lives, the back office could be killing your standing among patients and disrupting your cash flow. For some healthcare providers, the customer service function is neither customer-friendly nor friendly to the bottom line.
Every touchpoint you have with a patient is an opportunity to get things right and get things wrong. Some providers, however, are bleeding cash or receiving customer complaints but are unaware of the root causes or the solutions to fix them. Here are some of the danger signs along with suggestions on what healthcare providers can do to alleviate them:
Bad data. If you are seeing a spike in denied claims or worse, in billing errors, one of the major causes can be that the individuals who work in your registration or customer-service departments are not capturing and inputting the data related to insurance and other reimbursement programs properly. Many supervisors of the registration desk will attempt to move or reassign staff to fix the problem, or sometimes even install a new registration system, but the issues continue. Almost always the problem is a resource issue. You may be asking your staff to do too much.
Reduced self-pay recovery. For many providers, sometimes “self-pays” are “no-pays,” but it doesn’t have to be that way. Where many providers go awry is applying the same financial approach to self-pay patients as those with insurance or Medicare. Whether you like it or not, there should be different financial processes and workflows for self-pays. Many providers, however, find they do not have sufficient additional resources to give them the special attention they deserve.
Decreasing revenue from insured. Not only are payors paying ever closer to Medicare reimbursement rates, now we are entering an age when patients have high deductible, high co-pay, high co-insurance plans. These payments have to be made, and as the patient responsibility increases, recovery rates from those individuals fall. There has to be greater focus in the process to capture those dollars.
The solution? It all starts with registration
If bad data and reduced recovery from self-pay and under-insured patients are consistent challenges in your organization, you might want to look at the beginning of your patient encounter workflow for a solution. Registration and better, pre-registration, are by far one of the most important areas where providers can get the greatest return by applying increased resources.
Self-pay patients, for example, need contact earlier and more frequent by your organization. This population usually that has the greatest challenge in meeting their financial obligation, not contacting them early and explaining your credit policy can make the process of procuring payment much more challenging. Another challenge is that your staff may not have the resources necessary to make regular contact with your self-pay population.
Adding pre-authorization and pre-certification to your workflow, can reduce issues with bad data and decreasing revenue from insured patients by validating your patient data before you submit a single claim. As a result denials because of key errors or procedures that fall outside of coverage become less likely.
Focusing on registration reduces the workflow problems downstream. More importantly, the provider can establish an “expectation for payment” with the patient, as well as guide the patient through the insurance process at the outset, before that opportunity is lost.
The challenge for most healthcare providers is that even if you know you require additional resources, you are unable to increase headcount or increase the working hours of your existing staff. Often, you may not have the technical ability to perform some of these tasks. Providers with these challenges should consider outsourcing. Outsourcing does not have to mean entering into a long-term or expensive contract with a partner. The best way to begin is to utilize an outsourcing partner project by project. If you are backed up, especially in your accounts receivable or insurance claims, considering hiring an extended business officepartner to manage the overflow or have them back up your existing staff.
Logjams in revenue or workflow can be caused by issues at the front end of your patient encounter system. Be sure to analyze your entire workflow, not just the end, and with a judicious use of additional resources or outsource partners, you can break through and put your revenue cycle back on track.
Donna Strickland is Director of Key Accounts with ProSource Billing, Inc., a part of the Array Services Group family of companies. Donna has more than 35 years experience working with a variety of healthcare organizations to ensure both service and recovery needs are met while maintaining a high level of patient satisfaction.