Imagine the following scenario: Mrs. Jones has been experiencing back pain. Her doctor ordered an MRI to look for disc problems in the spine. Although the test was scheduled several weeks in advance, when she arrives for her appointment she is told that it has not been pre-authorized and she will have to reschedule. She also learns that she has a sizeable out-of-pocket expense due to her high deductible health care (HDHC) plan. She and her daughter, who had scheduled time off from work to bring her, leave exasperated.
This scene plays out daily in U.S. health care as pre-authorization and other financial clearance requirements bog down already over-loaded Patient Access operations in the vast majority of today’s hospitals. Most patient access representatives find themselves working same day and next day accounts, leaving little time to trouble shoot problems in advance. Patients are understandably upset, both by surprise bills and being turned away. Physicians are frustrated with an inefficient system. Patient Access professionals become demoralized, often resulting in high turnover.
Fortunately, there is hope to break this cycle. More and more health care organizations are partnering with a financial clearance center of excellence to better manage backlogs and relieve stress for everyone involved.
Offloading scheduled accounts
At our nThrive Financial Clearance Center, one of the first things we recommend is offloading scheduled accounts to our onsite experts. The theory behind this is simple: If we focus on everything that is scheduled out, this lightens the load for the onsite client team to focus on same day, no submission or Emergency Department (ED) accounts.
Our clients deliver their scheduled accounts through a live HL7 interface, enabling us to engage with patients as soon as they are scheduled. We then work the accounts up to an average of 5 to 10 days out, immediately contacting patients so they’ll know what to expect, including their personal liability. We also explore authorization status to determine if it is still pending.
The goal is to make sure patients have a predictable experience when they arrive at the hospital, giving health care organizations the opportunity to significantly improve patient satisfaction through the continuum of care so there are no surprises.
When you engage with nThrive
When one of our clients – a hospital with more than 400 beds – first engaged with us, they did not have a strategy on when to work accounts. Everyone was focused on immediate appointments, calling people the day before or the day of their service. Patients coming in would often be told that they didn’t have an order, that they’d have to wait for the order to come in, or that they didn’t have an authorization. The service had to be canceled and rescheduled. The wait times were through the roof because everything happened in fire drill mode.
Our first action was to create a strategy, immediately offloading some of the work to provide relief. We decided to take on all the accounts that were scheduled at least 3 days in advance.
Since we weren’t working right in the moment, we were able to coordinate our efforts with physician offices to determine whether patients were waiting on an order, if they had failed medical necessity, and whether their authorization was complete.
When we started in January, this health care organization was averaging one and a half days out. As of April 15, they are now 11 days out – and they are also averaging a 92% clearance rate!
Building on expertise
nThrive delivers this level of support through a team of experts located in its newly launched Financial Clearance Center (FCC), located in Raleigh, N.C. The FCC is a PCI-certified Center of Excellence, enabling its staff to discuss payment over the phone and process credit card information. PCI certification ensures that the proper technology and rules are in place to prevent fraud.
Along with advanced scheduling, collecting the patient’s payment prior to service is an essential part of successful revenue cycle management. For instance, if we revisit the Mrs. Jones scenario, just imagine the impact on finding out the day before or the day of that her out-of-pocket payment is $1200+ because she hasn’t met her deductible. That’s a pretty big financial hardship for patients who aren’t expecting it. However, if we contact Mrs. Jones 11 days out, this gives her almost two weeks to plan financially on how to cover her responsibility at the time of service. By providing patients more time, point-of-service collections and patient satisfaction naturally go up.
A lot of hospitals are struggling today with cancellations and reschedules, and the top reasons are no authorization, or, the patient cancels because they didn’t know about or can’t afford the financial responsibility.
When patients cancel the day of, this creates down time and results in lost income for the hospital and the physician. If patients cancel two weeks out, there’s time to reschedule someone else into the spot.
Depending on the policy of the health care facility, we also work with patients on other options such as quality payment programs. Additionally, some organizations offer sizeable discounts ranging from 10-25% for patients who pay in full prior to service. We have found that the larger the discount upfront, the higher the benefit, as upfront payment eliminates other collection expenses.
Growing physician satisfaction
One other benefit is improved physician satisfaction. In the case of the client previously discussed, complaints from physician offices were a common problem with such comments as “Don’t you understand we are running a practice here? We can’t drop everything to get an order for a patient. You should have called beforehand,” or, “We’ll try to do it later.”
Now, since working accounts ahead, we can show physicians a consolidated list of appointments and let them know “this is what you have outstanding.” We are not interrupting their practice and they are also able to provide a better patient experience.
When things are last minute, patients also get frustrated with physician offices, especially if an appointment is canceled. Now, the physicians can do their part at the beginning or end of their day, not interrupting clinical hours.
Improving patient, physician and facility satisfaction
Ultimately, better financial clearance is a win-win-win for patients, physicians and hospital facilities. Patients are happier and POS collections increase, while denials and bad debt decrease.
Achieving this level of performance is possible through nThrive’s team of clearance experts who are skilled in physician coordination, patient contact, point-of-service collection, insurance verification and more. Having a pool of people with varied backgrounds who can work all aspects of health care financial clearance makes it possible to dramatically increase volume, with the FCC typically handling 20% more accounts than staff resources.
Clients who engage with nThrive also gain access to the latest technology solutions, further improving revenue cycle performance at your health care organization.