The increased prevalence of high-deductible health plans is having an impact on Patient Access. With this new financial responsibility that lies heavily on patients, there are new functions, a new focus on upfront collections, and greater significance for the way a patient interacts with healthcare staff when it comes to increasing the amount being collected at the point of service. Healthcare providers are asking the frontline staff and other Patient Access colleagues to do far more and assume greater responsibility. In essence, we’re asking them to not only understand the complex regulatory landscape and their role in communicating with patients, but also some of the requirements around the new health plans.
Patient Access Effectiveness is Essential for Healthcare Revenue Cycle
In this kind of environment, where patient consumerism becomes a driving force, Patient Access is where patients begin their interactions with your health system as well as your revenue cycle. Such prominence underscores the importance of healthcare colleagues who are sitting at front desks, collecting and verifying insurance information, talking about patient financial arrangements, and taking scheduling calls—their significance increases exponentially. We all are already aware of the extent to which consumers want to know the price of things—in healthcare this strong trend applies to the cost of any care provided, which requires staff to be knowledgeable regarding insurance benefits and able to communicate effectively about payment liability.
Understanding Often Requires Education
The communication burden falls on Patient Access because organizations and patients expect them to be able to explain regulations, the billing process, cost and expenses, insurance, and coverage. Yet, in much of healthcare, we do not offer the necessary education for this group. The impact on healthcare providers is what you would expect. For example, when it comes to insurance claim denials, a significant number of the errors could have been avoided if individual patient access employees were trained adequately, provided the process and methodology to do their jobs, and understood why it is important.
In the absence of formal training programs, learning to prevent common Patient Access problems may be fragmented, leaving patients and the organization in the lurch. Healthcare organizations need a formal process to train patient access staff to understand not only how to handle such issues as no prior authorization, but why it is done, the rules and regulations around it, and what information needs to be verified. That way, the nightmare of patients receiving a huge bill for an MRI that was denied by insurance, which they wouldn’t have received if the patient access person had done their full job, can be avoided.
Patient Access Education in Action
In a recent article on hitconsultant.net, co-authors Beth Ottinger, Senior Director of Educational Consulting and Quality at HealthStream Partner nThrive, and Michael Maggard, Executive Director of Patient Access for Mission Health System, wrote about how they used education to build and strengthen Mission Health’s patient access workforce, which resulted in a “positive impact it had on the department as well as improvement in Revenue Cycle Key Performance Indicators.”
Some features of the Mission Health program included:
All quotations are from:
Ottinger, B., and Maggard, M., “Solving the Patient Access Labor Supply Challenge,” HIT Consultant, 06/27/2018, Retrieved at https://hitconsultant.net/2018/06/27/patient-access-supply-challenge/.Learn more about HealthStream Revenue Cycle Solutions, including Patient Access training from nThrive Education, click here
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