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Major Trends Affecting the Patient Access Workforce

April 1, 2021
April 1, 2021

Our 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.

High Deductible Health Plans Have a Major Impact

The increased use of high-deductible health plans is changing many processes and functions for patient access. Franko shares, “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.” As a result, “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.” 

The Demands of Patient Consumerism

In a workplace with these expectations, where patient consumerism is a strong 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.” We are empowering patients to act more like consumers, but consumers usually want to know the price of things before committing to a purchase. In healthcare this means the cost of their care, which requires that staff have to be able to answer questions regarding insurance benefits and communicate well and knowledgeably about payment liability. Franko shares how “the lack of expectation setting can influence the patient’s behavior and ultimately how they perceive the service.”

Patient Access Communication Has Never Been So Important

According to Ormondroyd, the communication burden falls on patient access because we expect them “to be able to explain regulations, the billing process, cost and expenses, insurance, and coverage.” In the face of this responsibility, however, he admits that “across our industry, we do not offer the necessary education for this group.” When it comes down to reducing claim denials, a significant number of the errors “could have been avoided if the individual patient access employee was trained to do some of these things, provided the process and methodology to do it, and understood why it’s important.”

Better Training Can Help Prevent Insurance Disasters

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."

Read the Article. Access the Webinar Recording.