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The patient’s financial experience has become extremely important to patient access departments, but data are not easy to collect.
Hospitals usually do not include questions about financial practice in satisfaction surveys. “This is due to the many delays it can take with insurance to process and for them to get a bill,” says Stephanie Benintendi, MBA, CHAM, director of finance and operations at Children’s Hospital Colorado.
Today, some departments are using a “financially cleared” key performance indicator (KPI) from the National Association of Healthcare Access Management (NAHAM)’s AccessKeys. “Just having one component in place and doing it well does not generally speak to the overall effectiveness of the program,” notes Benintendi, chair of NAHAM’s Industry Standards Committee.
“Financially cleared” means preregistration demographics are collected and verified, insurance is verified and active, all necessary authorizations are obtained, all medical necessity checks are in place, a price estimate is completed, and the patient is screened for additional assistance. For those who do not meet the criteria, arrangements are made for collections or to set up a payment plan.
One obvious challenge with financial clearance is it covers so many processes — scheduling all the way to financial assistance. “If there is a centralized department, where all of this reports to one central manager/director team, then it all is encompassed into patient access,” Benintendi notes.
Many hospitals operate with decentralized processes. The scheduling team reports to managers in each clinical area. Preregistration reports to a patient access manager. Insurance verification reports to a financial service manager. “This makes it hard to hold other departments accountable to the activities you need them to perform in order to hit the goal,” Benintendi observes.
Even departments that have worked hard to improve financial practices find room for improvement. “A common gap we find is that many organizations have not adopted estimates,” Benintendi reports. Providing an estimate, and collecting based on it, allows the organization to score higher on the preregistration process. For many, the problem is consistency. Some departments give estimates only for high-dollar diagnostic procedures. Most hospitals are not offering estimates for surgical procedures or for emergency department visits.
“It’s harder to get all of the CPTs loaded that make up the charges for the contract manager to evaluate for any stop losses or carve outs,” Benintendi says.
NAHAM also created a new “transparency” domain. This groups together the relevant KPIs (consistently giving estimates, the estimate accuracy rate, and identifying financial responsibility early). Another related KPI tracks the conversion rate of uninsured patients to a financial assistance plan. “This ensures you are following 501(r) requirements before sending a patient to bad debt for their portion,” Benintendi says.
Some states also require surprise billing disclosures to be obtained from each patient. “This ensures they understand their out-of-network benefits, and what options they have, before they even incur the expense,” Benintendi explains.
Patients want confidence that estimates are correct. “It creates trust that the hospital cares about their financial health as well as their physical health,” Benintendi offers.
Hospitals that outperform other similar facilities have something to point to. “That is something to totally capitalize on and market as a differentiator,” Benintendi suggests.
Many hospitals start with a “good” rating from the AccessKeys. If so, patient access can use this rating to make a business case for needing upgraded technology to receive a “better” or “best” rating.
“A technology capital ask from a non-revenue-generating department is one of the hardest uphill battles to make with IT and senior executives,” Benintendi laments. Creating a dashboard of the AccessKeys benchmarks, and where the department stands currently, is a powerful tool. “This is a great visual for senior leaders to discuss at monthly or quarterly revenue cycle steering committee meetings,” Benintendi says.
Accounts can be financially cleared in many ways, with point-of-service collections, payment plans, or financial assistance. “Each area of patient access contributes to the success of a financially cleared patient,” says Melissa A. Salyer, CRCR, a founding member of NAHAM’s Industry Standards Committee and vice president of implementation at AccuReg.
The hardest part, says Salyer, is “determining the source of truth for the data.” Data can come from registration systems, billing systems, or various third-party sources. Once that is sorted out, patient access sees significant benefits to resolving accounts on the front end. Patients avoid accounts going to collection. Sometimes, patients avoid catastrophic medical bills.
“Imagine the positive experience for a patient who qualifies for a hospital financial assistance program being identified in advance, and that assistance being given before the bill drops,” Salyer offers.
For hospitals, there is less money to collect, fewer A/R days, and less aged A/R and bad debt. “Leading practice includes having the financial conversation early in the preregistration process for scheduled visits,” Salyer says.
Patients expect to be able to electronically access all kinds of healthcare information, even price estimates. Often, patients cannot factor in their own insurance coverage to price estimates. “This would be an opportunity for the hospital to add technology to provide that solution,” Salyer suggests.
Tracking transparency metrics “allows hospitals to identify gaps in internal processes, improve those processes, and possibly gain a dedicated patient to their brand,” Salyer adds.