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More patients have access to insurance coverage today, but they also have higher out-of-pocket responsibility.
"Our greatest challenge is getting the information we need to verify healthcare benefits and coverage for their stay," says Susan Kole, director of patient access at Saint Francis Hospital and Medical Center in Hartford, CT.
The sooner your staff members have this information, the sooner they can reach out to patients and make them aware of their out-of-pocket expenses. "We are working with our schedulers to identify self-pay patients and those with high deductibles," reports Kole.
If staff members know this information at the time of booking, it gives them more time to identify all options for financial assistance and to offer payment plans. "Ideally, this discussion should take place in the physician’s office," says Kole. "The more information the patient has, the easier it is for them to make the right decision for their care."
Patient access leaders are working with OR schedulers to add questions to the scheduling questionnaire. At the time of booking, schedulers will do the following ask whether the patient is insured, and if so, whether the plan was bought on the Health Insurance Marketplace. Schedulers then will identify if there are special rates for specific procedures that should be collected at the time of, or prior to, admission.
Previously, scheduling and registration systems were not integrated. "Now that we are on an integrated system, our registrars and auth specialists will be able to start the process as soon as the case is booked," says Kole.
In moving financial counseling to the front end, says David Kelly, director of revenue cycle at Mary Rutan Hospital in Bellefontaine, OH, "you need to determine what teeth,’ if any, your institution wants to have when a patient falls through the cracks."
Managers also need to decide whether to combine scheduling, pre-registration, and financial clearance process into a single call — what Kelly calls "schegistration" — or call the patient back later. "The former might make the patient happier, but yield less reliable information," says Kelly. "The latter is a dissatisfier because of the two calls but allows for very accurate capture of patient information."
Some hospitals route calls to financial counseling if the patient schedules a service, but use the two-call method if the physician’s office schedules for the patient. "This seems to work well. But smaller institutions such as ours may have trouble with the systems and personnel to support such a plan," says Kelly. "We’re currently investigating how to design this project best for an institution our size."
In preparation for moving things to a "pre-service" model at Mary Rutan, patient access leaders are scrutinizing the entire process.
"We believe there are significant gains for patients, physicians, and referral sources, and the hospital," says Kelly.