Ray de la Pena | Feb 06, 2020
Medicare Beneficiary Identifiers Accelerate Claim Payment
(4 min read) On January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) made the formal shift to the use of
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(5 min read) The domino effect of rising deductibles, increased patient financial responsibility and the ensuing impact on provider reimbursement has catapulted patient financial experience to the forefront of healthcare conversations. A growing number of patients are struggling to cover the out-of-pocket costs associated with high deductible health plans. As this new tier of self-pay patients swells, traditional collections methods are under-performing for many healthcare organizations.
This new hurdle in the patient financial journey negatively impacts patients and providers alike. It can also lead to friction in the patient-provider relationship. To mitigate these challenges, new solutions are needed to address patient financial roadblocks and reduce the time and effort it takes for providers to collect.
Improving the patient financial experience starts by enabling providers with better tools to manage financial processes. Many practices remind patients that they’ve got a procedure coming up, but there is also a need to let the patient know what to expect by way of costs.
Technologies that streamline revenue cycle workflows and promote greater transparency in medical billing help providers remedy common pain points in patient collections. By leveraging the right tools at the right time, healthcare providers can improve revenue capture while maintaining a positive provider-patient relationship.
Time-consuming manual processes are a costly administrative burden for providers and contribute to patient frustration with medical billing. The problem is compounded for healthcare organizations as self-pay patient volumes climb. Automation of financial processes that touch all patients helps providers overcome this issue. Common financial processes include:
Tools that automate and consolidate common tasks enable billing teams to reduce processing times and the overall cost to collect for providers.
The timing of these processes is equally important to improving billing workflows in healthcare organizations. Aim to migrate these tasks as close to the front end of the billing process as possible. By doing so, billing teams can avoid downstream hiccups related to missing, incomplete, or inaccurate data, which are common culprits in claim denials and returned mail. By automating the right tasks at the right time, providers can significantly reduce reimbursement cycle times.
With the right technology solutions in place, healthcare organizations can pare down multi-step financial processes to a single automated workflow. For example, during the initial patient encounter, the first billing step is typically insurance eligibility verification. If no eligible insurance is found, the next step is to verify that the patient demographics are correct. Once patient data is confirmed as accurate, the billing team may then run insurance discovery to identify an alternate payor source for the patient. Perhaps the patient failed to report an insurance change and a new carrier is identified. The billing team would then verify patient eligibility and deductible amounts due.
Manually performing these tasks is inefficient and drains staff resources. Use for paper forms to complete processes grossly exacerbates the problem.
ZOLL AR Boost solutions enable providers to automate these steps in one simple query. Workflows are customizable because processes run on a single, unified interface, streamlining patient throughput and allowing billing teams to process more claims in less time and with fewer errors. In addition to improving billing department efficiency, automated insurance discovery features help providers find 20 percent more insurance coverage for self-pay patients, on average. This garners healthcare organizations a tremendous boost in revenue, saves write-offs, and reduces pass-off to third-party collections.
By consolidating tools into one automation-enabled technology platform and bringing processes to the front end of the revenue cycle, registration staff has all of the information needed to have more fruitful financial conversations with patients at a much earlier point of engagement.
ZOLL AR Boost solutions couple real-time insight into how much of the patient deductible has been met with self-pay patient analysis tools so healthcare organizations are equipped to offer payment plans earlier in the patient engagement process. Up-front analysis of patient financial health helps billers know where a patient falls in federal poverty guidelines for their state so they can pre-determine the patient’s propensity to pay. Billers can then identify a payment scenario that is manageable for patients who have a high propensity to pay but may simply need more flexibility in payment arrangements, reducing the number of accounts sent to collections.
Patient financial health assessment tools also help billers avoid spending time trying to collect money from patients who are unlikely to ever meet payment thresholds. When determining charity care eligibility—which depends on patient income and household size—it’s important to understand patient propensity to pay factors. To ensure a positive financial experience for each patient, everyone on the billing team should understand the healthcare organization’s charity care qualifications and who to refer the patient to for payment plans. Billing team members who interact with patients should be comfortable having those financial conversations and be aware of the appropriate next steps to recommend.
Technology used in the right place and at the right time directly impacts providers’ ability to facilitate a positive patient financial experience. Instead of hiring additional back-end resources to manage increased call volumes and collections efforts related to the rise in self-pay accounts, healthcare organizations should invest in automation resources that streamline front-end processes. In most cases, providers can implement and begin using these tools in a day. Efficiencies gained easily outweigh any short-term process interruptions during implementation. These tools support the end goal of a positive billing experience for the patient and have fewer steps for providers to collect for healthcare services rendered.
Interested in improving efficiency and revenue capture in your billing department?
Contact ZOLL to learn more.
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Broomfield, Colorado 80021 U.S.A.
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