Perfecting patient access is the key to strive for excellence in the healthcare payment lifecycle and maximizing pathology reimbursements. It is the first encounter of patients with the lab practice that is the base to boost their experience. However, this aspect is highly related to a major area that is healthcare RCM.
RCM teams get the reimbursement and medical billing right in place the first time around during the patient access process. For instance, registration is compulsory to verify and obtain the insurance/demographic data of a patient. This information is needed for complete or accurate reimbursement later.
Although, patients often get confused with their financial responsibility and prior authorization process due to limited understanding of their plans or insurance coverage. Lab practices should educate the patients about the informed or solid choices about their care and navigate them throughout the entire process.
RCM specialists verify data and clear patients financially for their scheduled services. They discuss/collect upfront patient financial responsibility like deductibles-copays, etc. Therefore, these actions help you to streamline the healthcare RCM and your pathology lab billing services. This makes it easy and faster to get payer reimbursement and collect patient payments.
Thereby, you can meet all obligations by using advanced automation and leveraging real-time data, in terms of prior authorizations and efficiently verify the insurance or benefits of patients, discover existing insurance coverage, collect their portion upfronts, etc.
Challenges Of Patient Access & RCM
It signifies shortcomings of a pathology lab practice patient access workflows due to high claim rejections. 2020 analysis of denial rates by Change Healthcare indicates one shortcoming in four denial stems due to eligibility and registration errors. About a quarter of possible potential preventable denials can not be recovered, found by the analysis. Preventing avoidable and common claim rejections is possible when you ensure patient access staff complete eligibility verification and registration.
But, this could be burdensome for those practices relying on manual patient access workflows. As expectations rise and patients are becoming more informed or engaged in their healthcare, hallmarks such as bi-directional and automated communication with peers, advanced technology and software to enhance access to data, and optimize billing practices have become crucial to streamlined RCM. So, patient access is gradually transforming.
During the early days of COVID-19, maintaining social distance while registering patients as well as quarantining requirements was all a big challenge for patient access. While many healthcare organizations yet not engaged electronically with patients in early 2020 for any kind of registration. They were exploring ways that’s why they tend to tech advancement to reduce the stress to staff & ancillary areas. Other challenges include constantly changing payer requirements & long patient wait times.
Leveraging Data to Increase Revenue
eStatements leads when it comes to the ease of reviewing a bill. Though, only 28% of practitioners offer eStatements while 48% of them use manual processes and leverage paper for collections. Rebilling costs of a single patient and mailing paper statements can be costly to nearly 25$. This may amount to a large toll on the net revenue of your pathology practice when considering this across your whole patient population.
Regardless of this, confirm that your patients will enable you to send them eStatements- gather their emails. Subsequently, this will enhance your odds of the collection as your patients can have access to bills via patient portals and emails, etc.
Nowadays, patients are becoming more and more part of the financial equation as healthcare consumerism is continually growing. Automation and technology will enable you to present accurate and timely data so the consumers can better comprehend their financial part. Moreover, it is highly crucial that staff must have accurate information for onboarding patients. Before the patients arrive for care patient portions should be collected upfront.
Train Your Staff Well
Pathologists must ensure that their front desk staff is well-managed to deliver positive patient experiences. You must see the specific hallmarks to identify where your business is lacking. Is your non-clinical staff sufficient enough to manage the billing inquiries? Do they handle patients who are underserved and are not able to afford visits and certain procedures? Do you have agreed-upon or fixed responses for consumers who say they will later pay the bill so what if you can send them a bill via mail? Consider bringing in experts from an experienced payer contracting firm to work closely with your staff and improve your reimbursement process for the future. By doing so, you can find inefficiencies in your process and ultimately maximise the value from each payment processed.
Schedulers can redirect the consumers with high balances or past due to financial counseling. Prompting compassionate, appropriate responses is imperative. This will encourage patients without being forceful or before their upcoming appointment to pay directly after service.
Offer Virtual Visits
Every stakeholder involved can benefit from telehealth as it is the way of the future. Virtual visits enhance patient access. Patients’ time they spend in the waiting room of clinics, in transport to & from their practitioners’ office would be saved.
Furthermore, for a zero-dollar copay, many insurers offer telehealth. They can speak with a provider, hop on the device of their selection, and save money. Hence, increasing patient access can influence the source of revenue to the contractually obligated payer & reduce cost.
Optimizing Your Patient Access
Every lab practice struggles to collect patient payments. When considering how to collect successfully it is necessary to keep the patient experience and patient access in your mind.
Integrating innovative patient access tools is the way to protect your bottom line while improving the patient experience & streamlining pathology lab billing services.
