Why Revenue Cycle Management Needs to Focus on Patient Access Staff

Our recent HealthStream webinar, “Thinking Outside the Box: Leveraging Education to Drive Patient Access Initiatives,” featured two executives from our partner nThrive—Thomas Ormondroyd, President of Education & Analytics, and Erica Franko, Senior Vice President and Managing Director of Advisory Services—who are also revenue cycle staffing experts.

Our recent HealthStream webinar, “Thinking Outside the Box: Leveraging Education to Drive Patient Access Initiatives,” featured two executives from our partner nThrive—Thomas Ormondroyd, President of Education & Analytics, and Erica Franko, Senior Vice President and Managing Director of Advisory Services—who are also revenue cycle staffing experts. This blog post excerpts an article based on the Webinar.

Patient Access Importance Far Greater Than Perceived Level and Pay Scale

Ormondroyd begins by mentioning the outdated concept of patient access—“the people that smile and check people in.” He adds, “That can’t be further from the truth.” Ormondroyd offers, “There’s more responsibility and expectations” than ever placed on these individuals, even though “we haven’t really done a good enough job of providing education and knowledge” to them. Their responsibilities include “many detailed [and] difficult things like collecting money, giving financial counseling, and doing major tasks that have a significant impact on the revenue cycle.”

“They are also some of the lowest-paid individuals in the revenue cycle,” Ormondroyd states. One reason they deserve more focus is that “45% to 90% of claim denials could be prevented by doing a better job of verifying and gaining patient information.” Ormondroyd emphasizes, “If that’s where the majority of denials are coming from, then we need to make sure that staff is capable of ensuring information is accurate.”

Increased Patient Responsibility Elevates the Role of Patient Access

Franko shares how the increased prevalence of high-deductible health plans is having an impact on patient access, telling listeners, “There are new functions, a new focus on upfront collections, and in the way the patient interacts with your staff when it comes to increasing the amount being collected at the point of service.” Ultimately, “We are asking the frontline staff or patient access colleagues to do more. 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.”

In this kind of environment, where patient consumerism becomes a driving force, “Patient access is the gateway not only to your system but also to your revenue cycle; the importance of our colleagues who are sitting at the front desks, who are taking scheduling calls, increases exponentially.” Consumers want to know the price of things—in healthcare this means the cost of their care, which requires that staff are knowledgeable regarding insurance benefits and communicate well about payment liability. Franko shares how “the lack of expectation setting can influence the patient’s behavior and ultimately how they perceive the service.”Just one example of where to prevent denials is in the common case of no prior authorization. In the absence of formal training, learning to prevent this problem 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 the 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.”