Must-have technology for healthcare reform
Outdated tools equal lost revenue
There is no question that patient access departments must use available technology to prepare for the implementation of the Affordable Care Act. But what technology is going to be most important for patient access?
Hospital Access Management asked industry experts this compelling question. Here are their answers:
• Technology that allows staff to provide accurate and reliable patient liability estimates.
"Being transparent with the patients upfront regarding their estimated liabilities will improve patient satisfaction," says Marie-Louise Stanek, a consultant with Accenture Health Practice in Atlanta.
Staff members need to use price estimation tools based on clinical order information provided during scheduling, which allows them to estimate liability and alert pre-registration to collection opportunities prior to patient arrival, says Paul Shorrosh, founder and CEO of AccuReg Patient Access Solutions. "Then, if dollars estimated are not collected by point of service, communicate and escalate the situation at every hand-off point," advises Shorrosh. "We all know that a dollar collected pre-service is worth more than a dollar collected post-service."
The goal is for every staff member to be used as a patient reminder and opportunity to collect the balance estimated prior to service, he says.
• Eligibility verification tools, to identify patients who are eligible to enroll in health plans available on the exchanges.
Insurance eligibility software is needed not only to verify insurance eligibility, but also to determine patient liability amounts before, or at, the time of service, emphasizes Patrick Teta, a senior consultant with Revenue Cycle Solutions in Pittsburgh. The reason is that the projected increases in insurance premiums will likely lead to more patients selecting high-deductible health plans to cut costs.
"It will be vital for patient access staff to have accurate, up-to-date, patient responsibility information to address these amounts," says Teta. "Also, the projected increase in Medicaid enrollees will make it vital to check Medicaid eligibility on self-pay patients."
Web-based patient portals enable efficient online payments and are familiar to consumers, says June Yee Felix, managing director of Global Healthcare at Citi Enterprise Payments.
"They also simplify and reduce the effort and costs involved in accepting higher volumes and higher dollar values of patient payments," says Felix.
Increased adoption of some payment portal offerings might even help providers qualify for Meaningful Use credits, depending on the specific portal capabilities and deployment model. "These provide significant return in terms of increased patient collections, reduced billing costs, and an improved patient experience," says Felix.
• Propensity-to-pay software.
"Participants in the new health insurance marketplaces who choose the least comprehensive and cheapest plans will have much higher deductibles and copays than typical employer-based coverage," says Ken Perez, senior vice president of marketing and director of healthcare policy at MedeAnalytics. "Thus, patient access departments need to increase pre-service cash collections."
Due to higher out-of-pocket expenses, collecting also includes staff evaluation of a patient's propensity to pay, and screening patients for a variety of possible financial sources such as Medicaid, payment plans, loan programs, or charity care. Shorrosh says, "The more automated and simple these processes can be, the better patient access staff will be able to perform them. It will require a new generation of patient access technology to empower them to do more with less."
Perez says hospitals are increasingly concerned about higher uncompensated care costs resulting from patients not paying high deductibles and copays.
"Predictive modeling techniques to appropriately segment patients prior to service, in order to prompt registrars to take appropriate action, are critical," says Perez.