There was a time not long ago when a patient’s provider was the most influential determinant of where and how a patient chose their healthcare services. Patients felt loyal to their physicians and stayed with the facility regardless of how badly they felt about the rest of their experience.
Although feelings about a specific provider are still an important factor, today’s patients also expect a complete patient experience that is seamless, easy, and personalized to their individual needs. If they don’t find it with their current provider, many are more than willing to go elsewhere for their care.
The patient experience starts and ends with the revenue cycle from the moment they call for a service or appointment to getting their claims paid. Therefore, it is vital that your revenue cycle teams have the patient experience top of mind in their daily performance.
Although all areas of the revenue cycle should be focused on excellence in customer service, the following three areas are where most revenue cycle departments have the biggest opportunity for experience improvement.
Scheduling
Your scheduling department is often the first encounter that a patient has with your practice and sets the tone for the entire patient experience. This can also be an extremely hectic department for your employees. If a patient feels rushed or has the sense that they are “just a number” in your system, then you have failed at making that first great impression.
Having set KPIs and tracking for your scheduling team based on national benchmarks in the areas of low call abandonment, high patient satisfaction scores, and reductions in no-show rates will set the tone for both the patient experience and employee engagement.
Additionally, consider scheduling software or outsourcing companies that partner with your live team and help your in-house team create the best patient experience possible. This includes live outsourcing or software that can handle call, text, and email reminders, provides easy self-cancellation opportunities for patients, and allows for pre-registration updates and changes prior to arrival to avoid billing problems.
Eligibility and Benefits Verification
According to a 2016 MGMA analysis(1), the average practice spends approximately 12.64 minutes manually verifying eligibility for a single patient. That translates to 8.4 hours or a full FTE per day to check the eligibility on just 40 patients!
By automating eligibility and benefits with software, you can gain the assurance that your patient’s eligibility and benefits are accurate and up to date and better utilize your employees’ time by working on those verifications that come back as inaccurate or MGMA Staff Members (2016). Pre-verifying eligibility and benefits. MGMA.com incomplete. By additionally integrating your eligibility software with your EHR, you gain the added benefit of continuous checking and receiving responses within seconds for those that need further scrutiny and work.
Prior Authorizations (PA)
Claim denials are most often triggered by missing or inaccurate demographic details, invalid or incorrect insurance information, and missing prior authorizations for services that are being questioned for medical necessity. Of these, the most difficult to overcome by far is the prior authorization process.
Even the American Medical Association (AMA) has indicated that they believe that prior authorizations are “over-used”, “increasingly onerous” and create “significant administrative concerns”. (2)
The time-consuming process of having your revenue cycle team obtain a PA manually cannot be overstated. The grind of looking up and/or calling the multitude of health plans that require PAs for a variety of services and diagnoses is a huge burden on the revenue cycle team and in turn, causes delays in filing claims.
Many provider organizations are still utilizing manual prior authorization processes, and it is costing them dearly not only in patient satisfaction but also in revenue reimbursement and employee engagement.
By leveraging automated software tools that streamline PA practices, a revenue cycle department can significantly improve its PA turnaround time, reduce delays in billing, and avoid claims denials.
A patient who has a positive experience is far more likely to remain a loyal customer, and that, in turn, will positively impact your revenue cycle management performance. By rethinking your processes in these three areas and leveraging technology to build efficiencies and interactions, your revenue cycle department is well on its way to providing convenience and excellence in the overall patient experience.
(1) MGMA Staff Members (2016). Pre-verifying eligibility and benefits. MGMA.com
(2) Robeznieks, A. (2022, June). In 2018, payers agreed to reign in prior auth. The clock is ticking. AMA.com
