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Patient Access: RCM Challenges and Solutions

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Patient access sets the stage for all healthcare processes, including revenue cycle management (RCM). And the current state of patient access presents challenges to and opportunities for growing revenue and enhancing the patient experience.

The collective impacts of the pandemic and the healthcare labor shortage spurred many providers to hasten IT initiatives and partner with third-party vendors for extended-business office solutions such as medical coding and claims management. But a recent analysis found that many health systems still lag when it comes to digital patient access.

As healthcare costs rise and patients face greater out-of-pocket expenses for many services, patients are also choosing their providers more carefully. With increasing emphasis on patient experience and mounting pressure to improve reimbursement rates, providers must focus on patient access as a revenue-cycle imperative.

Patient Access Critical to a Healthy Revenue Cycle

“If you don’t have time to do it right,” asked legendary college basketball coach John Wooden, “when will you have time to do it over?”

With an effective patient-access solution, providers have a chance to accurately capture vital medical-record and claims data at first contact. Consider the ability to obtain demographic information and insurance details at the point of registration; this data may not be used immediately, but it becomes crucial as the patient pursues treatment and the claims process progresses.

Patient access is also an opportune time to financially clear patients and discuss or collect payment for any shared financial responsibility. As a recent RevCycle Intelligence article noted, getting patient-access information right the first time lays the foundation for a successful revenue cycle.

Capturing clean data at the earliest stage aids every revenue-cycle step that follows, from benefits verification through medical coding input to billing and claims management to accounting administration and credit resolution. The preliminary capture of accurate data further allows for the complete or assisted automation of later tasks.

In addition, a smooth patient access experience makes a positive first impression on patients. That impression can be sustained throughout the patient journey when patients don’t have to repeat or resupply medical history or insurance information at every stage.

“From the patient’s perspective, we are the first interaction for their visit,” one healthcare patient-access leader told RevCycle Intelligence in the aforementioned article. “How the patient experiences patient access can impact the remainder of their visit.”

Patient Access Challenges

You only have one chance to make a first impression, as the saying goes, and healthcare providers don’t often get a second chance to rectify patient and payer issues before they disrupt the revenue cycle. Overlooking or incorrectly recording data during patient access can slow the claims process and lead to denials.

High claim-denial rates or increasing numbers of claim denials often stem from gaps in patient-access workflow. One-quarter of claims denials can be traced to errors in registration or eligibility verification, according to a 2020 analysis of rising hospital claims denials; the study further indicated that about 25 percent of potentially avoidable denials ultimately go unrecovered.

A contributing factor to the avoidable mistakes that cause claim denials is that many providers still rely on manual patient-access processes. Despite the growing availability of and patient demand for digital solutions, a 2019 survey of patient-access executives found that 30 percent of health systems depended entirely on manual patient-access operations.

Yet a recent consumer survey by Experian Health indicated that more than 75 percent of patients who don’t currently use digital tools for patient access or other healthcare services said they would consider switching to a provider that offered engagement through a digital patient portal. Patients find the ability to schedule appointments and manage pre-appointment tasks like registration and insurance validation particularly advantageous.

The challenges of manual patient access amid industry-wide staffing shortages are compounded by the day-to-day issues patient-access teams already face: evolving payer requirements, changing Medicare and Medicaid rules, fluctuating patient-contact needs, etc.

Patient Access and an End-to-End RCM Solution

An escalating number of healthcare providers are meeting patient-access challenges through comprehensive RCM platforms. An optimal RCM solution is a holistic system that incorporates digital patient-access services to:

  • help increase registration capacity,
  • improve scheduling efficiency,
  • improve medical-record and claims-data accuracy,
  • amplify claim approvals,
  • accelerate reimbursements, and
  • reduce the length of the patient journey.

A recent Health Leaders article detailed how one hospital saved $20 million by adopting a new patient-access approach focused on front-end technology. Likewise, the Healthcare Financial Management Association’s 2021 MAP Award winners agreed that leveraging patient-access technology is key to driving revenue cycle performance.

An advanced RCM platform is designed for patient access and beyond. It is engineered for interoperability and uses artificial intelligence and machine learning to securely extract and share patient and payer data among key stakeholders.

Prior authorization, for example, remains an obstacle to delivering timely care for many providers. A recent MedCity News article about overhauling prior authorization reported that fragmented prior authorization processes often lead to care delays. However, it went on to say that AI-enabled systems that merge preauthorization and other patient-access and revenue-cycle operations foster a faster and more accurate data exchange between providers and payers. This allows both to anticipate and manage patient needs more capably while elevating the patient experience.

A single-source RCM platform incorporates connected solutions that span the entire revenue cycle, from first contact through payment resolution. It streamlines workflow, eliminates data silos and yields valuable analytics.

Integrating patient access and other revenue-cycle functions under the umbrella of a single platform can help providers maximize reimbursements from patients and payers alike. It also offers a means to engage patients more fully in their healthcare journey.

GeBBS Healthcare Solutions: Forward Thinking

GeBBS Healthcare Solutions is an acclaimed leader in healthcare technology, including end-to-end RCM services. GeBBS’s RCM solutions offer diverse opportunities for AI-based data-entry and claims-processing automation and provide real-time analytics that leaders can leverage to identify challenges, create knowledge-based solutions and recognize growth opportunities.

GeBBS is dedicated to helping its RCM partners achieve measurable cost-reduction and productivity improvements. GeBBS is proud to be rated as one of Modern Healthcare’s Top 10 Largest RCM Firms, Black Book Market Research’s Top 20 RCM Outsourcing Services and Inc. 5000’s Fastest-Growing Private Companies in the United States.

Contact us today at gebbs.com to schedule a consultation and learn how we can help you optimize your RCM strategy.

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