Success from the Point of Access

A Best Practices in Patient Access Checklist

Why did we ever relegate Patient Access—those vital, first moments when a patient enters the system for care—to nothing more than a registration process? It seems implausible that the first point in patient relations was ever treated as afterthought.

Today, we’re adopting elements of a consumerism model, approaching patients as customers and finally treating the registration process as the critical juncture it is in the revenue cycle. As we all seek to shorten the reimbursement and collection process, we’ve clued in to the fact that the beginning of patient interaction greatly affects the end results.

Patient Access is a provider’s chance to:
• secure accurate patient information and insurance eligibility verifications
• determine payment responsibility, expectations and review payment options
• assess coverage alternatives
• establish effective, positive patient communications

When the point of access is handled with care, not only do we come away with more accurate, complete information and proper determinations about payment responsibility, but patients do so also. A thorough, focused Patient Access process empowers providers and their patients. In some instances, we’re even able to obtain upfront collections thanks to the acquisition of correct information and cost estimations. All this positively affects the overall success of the revenue cycle.
As the transition to better patient access practices continues to takes hold, here’s a checklist to make sure your Patient Access processes are on the right track.

Well trained frontline staff: It’s essential that your Patient Access staff be well prepared to handle expanded roles. They aren’t just acting as registrars anymore; they’re customer relations pros, patient financial counselors, as well as referral and verification specialists. They need a solid understanding of the entire patient process, be nimble at using technology and at ease interacting with patient-consumers.

Real-time eligibility and benefits verification: Today, the Patient Access process can be largely automated through the use of real-time eligibility and benefits verification technology. With these electronic tools, frontline staff can immediately confirm and authenticate patient benefits, referrals, claim status and patient address/contact information. Obtaining reliably accurate information upfront streamlines the entire process going forward, eliminating loss of valuable time chasing down payments or correct billing addresses after care is rendered. Likewise, these tools keep the patient access process succinct and efficient—less daunting for patients and their families and best for all involved.

Upfront patient responsibility estimation: Because of consumer-driven health plans, more patients now act as payers on their accounts, though payment responsibility has been challenging to determine upfront. Recent advancements, however, have led to the creation of technology to calculate patients’ payment obligations. This foreknowledge enables frontline team members to offer counseling to patients who are required to pay at least a portion of their care at some point during the encounter. Patients who are informed regarding their financial responsibilities will be better prepared to meet those responsibilities in a timely manner.

Accommodations for upfront collections: In the consumerism model of healthcare, patient-consumers are given opportunity to pay—by check or credit card—at every turn for their convenience. With substantiated payment amounts calculated by aforementioned payment estimation tools, frontline staff can confidently request, receive and process upfront payments during Patient Access. Upfront payments ensure the revenue cycle runs smoothly and alleviates stress for patients entering the system.

Determination of necessary procedures based on third-party payer data: Prior to administering of care, it’s immensely helpful to determine if certain procedures are deemed medical necessities by government and commercial payers. New technology solutions provide institutional staff the core information and workflow tools to evaluate the necessity of certain medical procedures. These innovative solutions, automated for rapid response and accuracy, reduce the chance of unneeded procedures being performed.

Patient-friendly materials: All consumer-facing materials, such as forms, brochures, information sheets, financial estimates, billing statements and web-based content, must be written and created for the understanding of patient-consumers. Likewise, the language used during one-on-one interaction should be patient-friendly as well. We often call this approach being “transparent” to our patients, making the system and its inner workings not only viewable but understandable. It’s the little things that often matter the most in this effort. For example, while those of us in the industry may understand what it means to “adjudicate a claim,” the majority of patients will better understand “settle a claim.” Use of more familiar word choices and terminology even in conversation is sure to evoke more productive responses from patients.

Best practices in Patient Access get even better when providers treat them with continuity, as part of an interlinked, unified process in which one action directly ties to the next. By utilizing a single system to manage all administrative aspects of patient accounts—from access to adjudication— we can eliminate redundancies, illuminate account questions or errors quickly, and correct issues in just one place to populate the entire system with the right data. Through a well-trained frontline staff, advanced electronic solutions and patient-friendly materials, providers can operate more fluidly while providing better service, guidance and counsel to patient-consumers from the first moments they enter the system.

Emdeon has the solutions to keep your Best Practices in Patient Access checklist in check. To discover how Emdeon Patient Access Management Solutions can help Simplify the Business of Healthcare, call us at 877.EMDEON.6 (877.363.3666) or visit us online.

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