Revolutionizing Revenue Cycle to Set Patients up for Financial Success

We are living in an age of healthcare evolution where the typical patient-provider model has changed drastically.

Different from past healthcare dynamics, patients now exercise more control over their healthcare decisions than ever before. The transition from patient to customer, is a welcome sign that many people are taking a more active role in their health. However, this movement toward empowerment has also created new pressures in other areas of the care continuum, including revenue cycle management.

Collection Challenge: Self-Pay Patients

Many providers have responded to healthcare’s growing consumerism by enhancing care workflows or offering online tools that bridge common patient-provider divides. Innovative online scheduling applications and healthcare management portals are great way to promote a positive care experience while keeping patients focused on wellness.

What about optimizing experiences post-care? Where is there room for improvement?

In today’s healthcare setting, the patient experience doesn’t end once they leave the facility. Even if no out-patient instruction is given, in most cases there is still a patient account to resolve. If the financial stage of the patient experience, which starts with a hospital’s revenue cycle management, is lacking, it can often lead to problems down the road.

Newly empowered patients may be reluctant to revisit that hospital after a poor patient statement experience. They may also lose confidence in the hospital’s ability to meet their clinical needs. Those same patients may be less likely to schedule their annual wellness appointments—more than likely resulting in less revenue.

The transition to a value-based care system has caused both providers and insurers to adjust the way they do business.

Insurers have responded by placing more emphasis on high-deductible health plans (HDHP). The popularity of HDHP plans has made the self-pay patient a common thread running through most medical billing workflows. Collecting from self-pay patients is just one of many challenges facing medical billing offices in this evolved healthcare financial environment.

According to a Black Book Revenue Cycle Management survey, 83% of respondents stated lengthy collection periods from self-pay patients was a top RCM challenge. The survey also showed that 81% felt communicating patient accountability was another challenge in addition to the laborious rate of payment. Many of these issues can be reduced or outright eliminated if hospitals try to set patients up for financial success by:

  • Upfront communication of financial responsibilities
  • Building more transparency into charges
  • Clarifying insurance and self-pay billing process—internally and externally
  • Customizing patient billing statements
  • Continuing education of medical billing personnel

Just as their clinical counterparts are adapting to meet evolving patient demands, there are a number of adjustments hospital financial leadership should consider.   

Alleviating Revenue Cycle Management Pains

Start with Staff

The registration desk is the first line of defense. Staff should be proactive about catching any potential billing issues before they create bottlenecks in the RCM process through:

  • Ongoing training– Whether it is continuing education on medical coding or regular updates on health insurance trends, billing staff is the best financial education resource for patients. Ongoing training should also cover new billing tools and resources.
  • Upfront communication – Price transparency, proactive communication, and high patient engagement should be core values for front office staff. An 2017 report stated 92% of patients want to know what they will owe prior to receiving medical care. Communicate patient financial responsibility upfront and save headaches down the road.
  • Optimize workflows – If a hospital billing office is noticing lengthy time frames between registration and reimbursement, it’s likely there are inefficiencies in the RCM process. Look for bottlenecks and correct them appropriately.

Optimize Technology

If there are RCM bottlenecks, analyze the efficiency of the tools and solutions by asking the following questions:

  • Does the RCM automate and unify basic account management tasks?
  • Is the RCM platform setup correctly to identify coding errors?
  • Are statements and explanation of benefits (EOB) easy to understand?
  • Are patients provided with electronic payment or self-service options?
  • Is there a mechanism in place for identifying reimbursement discrepancies?

If an RCM platform is optimized the answer to all these questions and many others like them should be, YES. By optimizing medical billing technology to work alongside an optimized RCM workflow you can:

  • Generate bills in a timely matter
  • Send clear statements to patients and insurers
  • Increase insurance claim rates
  • Accelerate payments
  • Improve the patient financial experience

Consider Revenue Cycle Management Outsourcing

In some instances, such as a new EHR or significant staff turnover, outsourcing revenue cycle management tasks can help reduce some of the pressures. With fewer rudimentary tasks on their plates, internal billing staff can allot more time for coaching patients on how to be financially responsible healthcare consumers.

A dedicated RCM vendor can also work within a hospital’s system and help make sure the entire billing process is optimized. They can also actively monitor contracts, claims, and denials, resulting in faster billing, as well as less work and confusion for patients.

Informing and Empowering Patients Eases Payment Pains

More patient empowerment is good for healthcare, but it will require all the branches of a facility to respond in unison.

Industry change has caused the clinical side to adapt, and the same must occur on the financial side. Billing transparency, educated staff, and an optimized RCM platform are all keys to setting patients up for financial success. If these requirements have front office staff stretched to the limit, reaching out to an RCM partner can help.

Patient-centered billing practices plus value-driven care creates a holistic healthcare experience that can keep patients happy and committed at every stage of the continuum.

As patient populations become more empowered and financially informed, a hospital may start seeing more consistent payments, increased revenues, and an overall healthier community. All of this takes a ton of pressure off a hospital’s staff.

Further Reading:

The Challenges of Patient Billing for Community Hospitals

4 Critical KPIs to Track Your Facility’s Revenue Cycle

Revolutionizing Hospitals by Transforming Financial Systems with CFO Chelle Keplinger

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