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Not too long ago, some basic computer skills and the ability to collect demographic information were pretty much all that was needed for a patient access employee to succeed. Now highly skilled at upfront collections, financial discussions, and customer service, their role continues to expand both in scope and complexity.
“In the future, patient access will be expected to provide a personalized financial care plan, just as the clinical staff provide a clinical care plan,” says Sandra J. Wolfskill, FHFMA, director of healthcare finance policy at Healthcare Finance Management Association in Westchester, IL.
To perform their jobs, patient access will need a keen understanding of insurance eligibility, benefits, and managed care contracts.
“Consumers are shopping for services, based typically on price and quality,” Wolfskill notes.
Quality information is readily available online. However, the amount of money a patient is going to pay for a specific service remains a frustrating mystery for many. In turn, this drives dissatisfaction.
“Gone are the days when posting charges or providing charges as a proxy for the price would be acceptable,” Wolfskill says.
Today’s consumer wants much more than general information on cost. The new expectation: Patient access can take the hospital’s internal charge data, apply the consumer’s services, benefits, and the payer’s discount, and calculate a patient’s out-of-pocket cost. And if they can’t?
“There is a very high probability that the consumer who wants to know the price before receiving the service will migrate to the provider who can provide that information,” Wolfskill cautions. Most patient access departments can provide a reasonably accurate price estimate, assuming the right technology is in place.
“But it is essential to train staff to appropriately use that technology — and how to effectively communicate with the patient about the results,” Wolfskill says.
To do this, according to Wolfskill, the patient access representative of the future will need a much more robust understanding of insurance benefits, and how these affect payment; payer contracts, and how they’re applied to a specific service; and how claims are adjudicated.
Wolfskill gives this example: A patient has a commercial plan that receives a 27.5% discount off charges. The plan has a $2,000 deductible, after which the plan pays 80% of the discounted charges, with the patient responsible for 20%. There’s a maximum out-of-pocket cost of $6,000. If the patient already met the deductible, and $500 of the out-of-pocket cost, what’s the patient going to owe — and why?
“We have software to do the math in many organizations, but explaining it to the patient is critical,” Wolfskill stresses.
Scenario-based interviewing is one way to identify great communicators in potential new patient access hires. Wolfskill shares these tips:
“Or, do they speak in the acronyms of ‘hospital-speak,’ which is often not understandable to patients?” Wolfskill asks.
These important new skill sets are one way to measure the increasing clout of patient access.
“Organizations are recognizing that in many ways, patient access positions are becoming equal to — or even more complex — than patient accounting positions,” Wolfskill says.
By serving as the patient-facing segment of the revenue cycle, these employees can move the dial toward greater satisfaction.
“If organizations put their best and smartest employees in those patient access roles, the payoffs are many,” Wolfskill predicts.
Two very important examples for the revenue cycle: fewer claims denials and faster payment.
“There is also improved satisfaction, because the patient understands their bill in advance,” Wolfskill adds.