Must-have technology for healthcare reform
Outdated tools equal lost revenue
Executive Summary
Patient access departments need technology to determine patient liability, propensity to pay, and eligibility to enroll in health plans available on the exchanges. Revenue cycle experts say to expect these changes from healthcare reform:
- More patients will choose high-deductible health plans.
- Patients will need to be screened for a variety of possible financial sources.
- Out-of-pocket expenses will increase.
There is no question that patient access departments must use available technology to prepare for the implementation of the Affordable Care Act. But what technology is going to be most important for patient access?
Hospital Access Management asked industry experts this compelling question. Here are their answers:
• Technology that allows staff to provide accurate and reliable patient liability estimates.
"Being transparent with the patients upfront regarding their estimated liabilities will improve patient satisfaction," says Marie-Louise Stanek, a consultant with Accenture Health Practice in Atlanta.
Staff members need to use price estimation tools based on clinical order information provided during scheduling, which allows them to estimate liability and alert pre-registration to collection opportunities prior to patient arrival, says Paul Shorrosh, founder and CEO of AccuReg Patient Access Solutions. "Then, if dollars estimated are not collected by point of service, communicate and escalate the situation at every hand-off point," advises Shorrosh. "We all know that a dollar collected pre-service is worth more than a dollar collected post-service."
The goal is for every staff member to be used as a patient reminder and opportunity to collect the balance estimated prior to service, he says.
• Eligibility verification tools, to identify patients who are eligible to enroll in health plans available on the exchanges.
Insurance eligibility software is needed not only to verify insurance eligibility, but also to determine patient liability amounts before, or at, the time of service, emphasizes Patrick Teta, a senior consultant with Revenue Cycle Solutions in Pittsburgh. The reason is that the projected increases in insurance premiums will likely lead to more patients selecting high-deductible health plans to cut costs.
"It will be vital for patient access staff to have accurate, up-to-date, patient responsibility information to address these amounts," says Teta. "Also, the projected increase in Medicaid enrollees will make it vital to check Medicaid eligibility on self-pay patients."
• E-Cashiering.
Web-based patient portals enable efficient online payments and are familiar to consumers, says June Yee Felix, managing director of Global Healthcare at Citi Enterprise Payments.
"They also simplify and reduce the effort and costs involved in accepting higher volumes and higher dollar values of patient payments," says Felix.
Increased adoption of some payment portal offerings might even help providers qualify for Meaningful Use credits, depending on the specific portal capabilities and deployment model. "These provide significant return in terms of increased patient collections, reduced billing costs, and an improved patient experience," says Felix.
• Propensity-to-pay software.
"Participants in the new health insurance marketplaces who choose the least comprehensive and cheapest plans will have much higher deductibles and copays than typical employer-based coverage," says Ken Perez, senior vice president of marketing and director of healthcare policy at MedeAnalytics. "Thus, patient access departments need to increase pre-service cash collections."
Due to higher out-of-pocket expenses, collecting also includes staff evaluation of a patient's propensity to pay, and screening patients for a variety of possible financial sources such as Medicaid, payment plans, loan programs, or charity care. Shorrosh says, "The more automated and simple these processes can be, the better patient access staff will be able to perform them. It will require a new generation of patient access technology to empower them to do more with less."
Perez says hospitals are increasingly concerned about higher uncompensated care costs resulting from patients not paying high deductibles and copays.
"Predictive modeling techniques to appropriately segment patients prior to service, in order to prompt registrars to take appropriate action, are critical," says Perez.
Inadequate use of technology?
Expect decrease in cash flow
Many patient access departments still aren't doing any eligibility checking at all, according to Patrick Teta, a senior consultant with Revenue Cycle Solutions in Pittsburgh.
"Propensity to pay, ecashiering, and registration kiosks are mainly done at larger facilities," he adds. "Hospitals that aren't up-to-date will face rework downstream in the revenue cycle."
Most patient access departments, including pre-service and centralized scheduling units, lack the appropriate technology needed to be more efficient and to work smarter, thus eliminating the need for many manual and duplicative processes, says Marie-Louise Stanek, a consultant with Accenture Health Practice in Atlanta. "Hospitals often dedicate technology funding to those systems that are related directly to patient care, especially with meaningful use standards," she says. "This appears to be a common theme within healthcare systems, as well as smaller community hospitals."
Much of the focus regarding healthcare reform targets payment issues and the anticipated increase in out-of-pocket expenses, including higher deductibles and coinsurance, adds Stanek.
"Patient access departments that do not have the appropriate technology in place could experience a decrease in cash flow, as well as an increase in bad debt," she warns.
Patient access tools aren't always integrated
Department's success depends on it
In a busy patient access area, it is vital that tools are integrated into the hospital's information system, says Patrick Teta, a senior consultant with Revenue Cycle Solutions in Pittsburgh.
"Bolt-on" solutions can slow the registration process, negatively impacting patient satisfaction. "Any time you have to take your hands off the keyboard, or refocus your attention on an application outside of your registration system, it is going to add to the patient registration time," explains Teta.
Hospital information system companies have been slow to truly integrate bolt-on applications, says Teta, but some information systems have integrated insurance eligibility, charge estimation, cash drawer handling, and medical necessity into their registration screens. In some cases, patient access departments have Internet-based bolt-on systems to check eligibility, medical necessity, or propensity to pay, but employees don't use them because the connections are too slow, says Teta.
"Even if using a bolt-on product only adds one minute to a four-minute registration, you've increased your wait time and decreased your productivity," he says.
Tools working together
Patient access needs a suite of technology products working in concert with one another that match with every distinct patient access process that must be completed prior to service, according to Paul Shorrosh, founder and CEO of AccuReg Patient Access Solutions in Mobile, AL.
"Registrars don't need another eight tools. They need one tool that will do eight things automatically, with exception-based workflows, and performance management to ensure resolutions prior to service delivery," says Shorrosh.
There is no "silver bullet" to buy, he says. Instead, patient access leaders need integrated tools that allow employees to be successful in an increasingly complex work situation, Shorrosh says.
Estimation and eligibility verification are two obvious needs, but patient access can't stop there, he says. Address and identity verification, prior authorization management, medical necessity screening, and financial screening all need to be considered. "Reform will bring even more complexity and urgency to screening and verifying patients. There are multiple layers of payment risks to the facility, not just collecting liabilities," says Shorrosh.
Shorrosh says the best systems automate multiple business processes and distill the exceptions, warnings, errors, and opportunities into a simple individual work console for each registrar and pre-registrar.
"Timing is another success factor," he says. "The more we can do in scheduling and pre-registration, the better the entire healthcare system will work for patients and for providers."
