Payment to healthcare providers involves three key processes in the revenue cycle: Insurance follow-up, denials management, and self-pay management. Historically, the first two have rightfully consumed most of the attention from hospitals, doctors, and their business offices. But that was then, and this is now: With the rise of High Deductible Healthcare Plans (HDHPs), and shrinking reimbursement from government insurers, healthcare providers are seeing a large portion of their revenue tied up in patient receivables. With little experience on how to efficiently tackle this problem, providers are faced with a big challenge.
To help weather the storm, we have identified four objectives providers can accomplish to improve patient follow-up processes in the revenue cycle:
- Build more efficient workflows with a focus on compliance
- Understand your patients’ level of financial ability
- Enhance patient engagement with a full contact management strategy
- Manage disparate data sources for a single patient
Establish efficient workflows with a focus on compliance
Between 501(r), a newly-looming gaze from the CFPB, and continuously-evolving patient and regulatory demands, keeping your train on the rails while speeding up is a difficult but important task. As you build out your strategy for patient follow-up, compliance needs to be a key component in the process. Most providers understand the need to be well-versed when dealing with regulatory standards, but aren’t particularly savvy when it comes to TCPA, UDAAP, and other regulations that directly affect how and when they can contact and collect from the patient. Strict regulations governing how you gain permission to call patients on their cell phones is one example of limitations they put forth. As you navigate these obstacles and set up your processes, be sure to use resources like the insideARM Compliance Professionals Forum to ensure you have the right procedures in place.
Understand and act based on each patient’s ability to pay
Once you have these processes established, it’s important your operation comes to understand each patient’s financial ability. Some patients can afford to pay while others struggle. Determining these financial capabilities enables you to focus on helping the latter cases obtain financial assistance or charity care, in turn driving the approach with each group. For example, those with an ability to pay should not be contacted immediately after their visit. Give them time to reach out with questions or make the payment on their own from the statement they receive. On the other hand, patients with less of a financial ability to pay should be assigned them to financial counselors for qualification. The middle range group, those who could have some level of financial ability, may need structured, long-term payment plans. Reach out to these patients sooner than later so they understand their options before time elapses and they get too far behind.
Create multiple engagement channels
Once you have your process built and groups identified, providers need to build a full patient contact engagement strategy. Create multiple engagement channels beyond the usual statements, including online portal, IVR, and live agents to engage the patient on their terms. This not only helps to resolve the balance but improves patient satisfaction as well. With HCAP scores tying Medicare and Medicaid reimbursements directly to survey results from the patient, providers need to make the patient experience better enhancing every interaction with their billing process, including the billing experience. By building a patient engagement strategy through your contact management program, you end up speaking with the right people, at the right time, about the right information.
Combine all patient information in one place
Finally, providers need to pull all of the information from their disparate systems into a single integrated platform. Most providers inevitably have resulting from an acquisition, affiliation, or simply different versions of the same software. To the patient, the provider is one. Most find it difficult to understand why they get more than one bill from their provider. This creates inefficiencies at the CBO level as providers rely on multiple patient accounting offices, instead of managing a single, holistic process. Combining all of this data into one integrated system enables a single experience for the patient through all of your patient engagement touch points including your portal, IVR and inbound call center. It also improves productivity, giving you the chance to pool resources into one team. This gives you one patient, one system, one experience.
Flexibility is important when it comes to each and every one of these objectives. Some providers choose to outsource financial assistance processes and/or self-pay collections while others do everything in-house, or opt for a hybrid model. Whichever way you choose, ensure that these four objectives are made standard. Doing so more often than not results in an efficient, compliant process that provides the patient centric process you need.