Many have heard of patient-centric healthcare and how it improves patient experiences and clinical outcomes. Sometimes overlooked is the parallel shift in focus that is happening in the business of healthcare – the evolution of the patient-centric revenue cycle.
It has been well over a decade since our healthcare system started transitioning from volume to value-based care. A critical part of that change is the shift in financial responsibility from payer to patient via high deductible plans. Patients responsible for paying premiums and high deductibles are understandably cost-sensitive, and that consumer mindset greatly influences the patient-centric revenue cycle. A Black Book Survey found that 83% of providers plan to meet this new mindset with “retail-like technology solutions and practices.”
What is a patient-centric revenue cycle?
A patient-centric revenue cycle views the patient as a partner in the billing process and responds to the consumer mindset with clear communication and transparency about price and payment options. According to a speaker at the HIMSS18 Revenue Cycle Solutions summit, “bad communication equals bad debt.”
As a partner in the billing process, patients must understand their financial responsibilities and be held accountable for providing information for claims processing when required. Since healthcare is now viewed as a commodity, patients expect to understand costs up-front and have convenient and flexible payment options. They also expect claims processing and billing to be seamless. Even if the reason for a denial is due to misinformation on their part, any extra effort or frustration they experience to resolve a claim may encourage them to change providers in the future.
There are two steps to build a patient-centric revenue cycle. The first is to use a financial responsibility document as a foundation. The second is to mitigate denials at every opportunity.
Step #1: Clear communication
Ideally, the financial document should be available in several languages, signed to acknowledge understanding before the first encounter, and stored in the patient record.
Financial document components should include:
An outline of financial obligations
A central component in the patient-centric revenue cycle is easy-to-understand communication. Many organizations develop a document that outlines patients’ financial obligations for payer-approved claims such as copay, coinsurance and deductibles. Sometimes documents also include information about standard insurance protocols for authorizations and certifications, so patients understand their function in receiving care. It is essential not to overlook the consequences of denied claims (the patient may be responsible for the entire billed amount) and possible next steps (such as collections) for unpaid bills.
Sometimes patients don’t fully appreciate how accurate demographic and insurance information affects claim adjudication. The financial agreement is the best place to clarify that patients have a responsibility to ensure accurate information is on file with your office to avoid denied claims. Another step in the claims process patients sometimes overlook is their responsibility to respond to the insurance company about the circumstances that necessitated the visit, such as an accident. Payers will refuse to pay claims if they are awaiting information from the patient.
Cost estimation policy and payment options
Cost estimates are important to patients. The financial document is the place to let them know if estimates are available and how to request one. In addition, information about options for making payments, such as payment plans and credit-card-on-file, can help patients plan for large bills. If your organization has resources to help patients obtain financial aid or Medicaid coverage, the financial document should provide next steps and contact information to learn more.
Step #2: Avoid denials with next-generation RCM technology
With patients more sensitive to the billing process than ever before, denials must be avoided to retain patients. A HIMSS Analytics survey found organizations using three or more RCM systems alongside their EHR reported the most trouble with denials. Next-generation healthcare business assurance technology can help mitigate denials by continuously auditing all claims platforms. Predictive analytics, a central component of business assurance, is another tool that allows providers to predict possible problems with authorizations, charges and claim adjudications. Real-time alerts signal potentially denial-inducing circumstances and allow information updates and corrective action to be taken before a claim is generated - oftentimes while the patient is still in the facility - therefore improving the patient experience by avoiding surprise billings afterwards.
Establishing clear communication about billing and payments, combined with a claims cycle that mitigates denials, lays a solid foundation for patient retention and consistent cash flow. Now is the time to take stock of your operations and use revenue cycle best practices, including business assurance technology, to ensure a patient-centric revenue cycle that will serve both your patients and organization for years to come.
Interested in learning more about how next-generation business assurance technology can drastically reduce denials and boost patient satisfaction? Contact Effy Healthcare today to discover how we can help your organization.