Financially clearing accounts earlier has never been more important, as hospitals’ budgetary issues continue.
“Early financial clearance is the foundation of the patient access department,” says Alyssa McDonnold, director of patient access at Maury Regional Medical Center in Columbia, TN.
A centralized preservice department handles scheduling, preregistration, precertification, and financial clearance for all three of Maury Regional Health’s hospitals. “The key is keeping track of how many days out accounts are being worked — and how many of them are financially secured,” McDonnold says.
That means insurance is verified, precertification is obtained, and some kind of payment arrangement has been made. The department’s goals are twofold:
- For 90% of all admitted patients to be financially cleared at check-in;
- For staff to collect 30% of total estimated out-of-pocket charges.
“We are currently averaging 43%,” McDonnold reports. “Our preservice department collected over $100,000 for the first time ever.”
Preservice teams are assigned a day or date range for which they are responsible. Previously, a group of staff struggled to complete precertification and preregistration for all the next-day accounts. Now, employee 1 works all next-day accounts, employee 2 works all accounts two days out, employee 3 works all accounts three days out, and so forth. “This caused a divine balance in our preservice work flow,” McDonnold says. “After a few weeks, the work flow evened itself out.”
Before the new process, some patients did receive a call. The problem was it did not happen early enough to resolve the account before the service date. “We hardly ever got beyond two days out because there was so much work for patients who were coming in tomorrow,” McDonnold says.
Now, patients are called as they are scheduled, up to five days out. The daily “secured at admit” rate (meaning the account is financially cleared and authorization is in place) for preservice accounts averaged 62% at first. It recently hit 90%, and averages about 70%. The department fully expects the number to go even higher.
Financial clearance of surgical accounts has become a top priority at Augusta (GA) University Health. “We are ramping up processes that will allow us to reach out to patients prior to their surgical date,” says Lee Patillo, director of registration and preaccess services.
All of it used to happen only when the patient checked in for surgery, resulting in needless stress. Today, the process is completed days earlier. First, the surgery coordinator contacts the patient to verify demographic and insurance information. Concurrently, the patient learns the amount of copays and deductibles. “This process allows for patients to move through early morning registration efficiently with peace of mind,” Patillo says.
If the process works as it should, patients do not receive surprise bills later because of unpaid claims. “Our initial first-pass denials related to surgical authorizations have been cut almost in half,” Patillo reports.
An estimator tool calculates the expected out-of-pocket amount. The amount can change if additional codes are needed, but it is a starting point. “In general, it provides a basis that the patient can use for budgeting,” Patillo says.
If clinicians select an incorrect code, the estimate will not be accurate. Recently, patient access worked with Health Information Management (HIM) to tackle this problem. A HIM coding representative reviews the clinical documentation before the surgical coordinator obtains the authorization. “Without this process in place, hospitals run a risk of inaccurate codes, which may lead to denials,” Patillo says.
The department cut the number of “no auth” denials for surgical cases in half. Copay collections also have increased because of the preregistration calls. “The expectation is to double our current copay collection rate for scheduled surgical services by end of calendar year 2020,” Patillo says.
Elective outpatient nonsurgical patients are preregistered at the same time they are scheduled at Naperville, IL-based Edward-Elmhurst Health. This is a recent change for the department. “We began reviewing patient liability and calling patients to review their coverage and any patient responsibility,” says Jim Economou, system director of patient access and the preservice center.
Some patients self-schedule online. If so, they can simultaneously complete their preregistration beforehand. “We have been working on moving more automation to patient estimates,” Economou reports.
Patients are learning their out-of-pocket costs right at the point of scheduling. “This allows us to reallocate our resources,” Economou notes. “We can focus on financially clearing more accounts.”