By Jason Williams
February 22, 2017 at 5:00 am ET
Some things go naturally together. Pen and paper. Chocolate and peanut butter. And here’s a surprising one: patient access and revenue cycle analytics. You may have never thought of bringing the last two together, but no one thought of bringing chocolate and peanut butter together until it happened. Well, hospitals can make their revenue cycle much sweeter by applying revenue cycle analytics to improve patient access, and we can show you how. But first, some context.
The use of revenue cycle analytics solutions to improve front-end processes is lagging. KLAS Patient Access research looked at 98 providers’ frequency of using financial clearance technology to improve billing/collection and reduce denials. The overwhelming majority (99 percent) used eligibility verification, followed by patient responsibility estimation (76 percent), patient address/ID verification (68 percent), registration QA (66 percent), and point-of-service collections (56 percent). Just 34 percent used performance analytics to improve billing and collections.
We can’t be sure as to why people aren’t investing more in analytics. The ability to analyze and use patient access data to guide process improvements can help drive significant improvements — potentially totaling millions of dollars for a single facility. So let’s look at how revenue cycle analytics can be used to help improve the patient access function, boost registration and eligibility accuracy, and reduce downstream denials.
Reimbursement Tops Patient Access Priorities
After ensuring a quality patient experience, two top priorities for a patient access department are to secure correct reimbursement from insurance and from consumers. Of course there are other priorities, but reimbursement tops the list.
The rise of consumerism and complexity of emerging payment models challenge providers more than ever to secure timely and correct reimbursement from both. Ultimately, the success or failure of these collections begins at the front-end of the revenue cycle. This makes the patient access function more important than ever, not only because registration/eligibility errors account for the largest percentage of denials, but because patient access contains vast amounts of untapped data.
Denial Prevention & Management
Denial prevention and management requires two things: First, new levels of visibility and knowledge of where and why problems originate on the front-end.
Second, prevention and management requires staff flexibility to change processes and workflows to which they have grown accustomed. This is where patient access analytics comes in. Strategically addressing denials with an analytics-driven approach can improve the efficiency of the entire revenue cycle, accelerate reimbursement, and boost overall revenue cycle performance.
Consider what happened to a 600-bed system that had overall denial rates substantially higher than comparable health systems. It analyzed why denial rates were so high and found that registration and eligibility issues were the primary denial causes. Based on that analysis, it targeted specific patient access processes, and the related registration/eligibility denial rate plummeted from 11.66 percent to 1.23 percent. Over a four-month period, that led to $2.4 million in revenue paid on initial submission.
Using Analytics to Pinpoint Front-End Issues
With 30 to 40 percent of denials stemming from front-end registration/eligibility issues, providers need to understand how the up-front patient access process affects collecting payment for the care they provide. Analytics can pinpoint what shortcomings in the process lead to denials or non-payments — and exactly how much additional revenue providers can expect if they make operational and process changes.
Determining the correct insurance reimbursement and the right consumer out-of-pocket at registration is vital to collecting payments down the road. So is securing pre-authorization for specific kinds of services upfront. Patient access analytics can also identify at what point payments should be collected from specific patients: at the point of service, at pre-discharge and/or post-discharge, to increase collection rates. Patient access analytics can also help identify how efficient a provider’s patient access workflow is, and pinpoint ways it can be improved.
Again, there’s no shortage of analytics tools on the market, but what hospitals and health systems need are analytics that are built for the value-based era.
What to Look for in an Analytics Solution
Not all analytics solutions are equal, particularly when it comes to offering insights into the patient access process. When choosing, look for a solution that supports consumer effectiveness (the ability to provide credible, defensible estimates) and insurer effectiveness (the ability to pinpoint process issues related to eligibility and authorization). Avoid tools that cannot analyze historical data trends within and across facilities and drill down to identify the primary causes of issues. Take special care that any solution you consider offers actionable visibility into eligibility and registration processes to support root cause analysis and help guide corrective action that can positively impact downstream results and cash flow.
Here’s an essential capabilities checklist for an analytics solution to help improve patient access performance:
Mind Those Metrics to Improve Hospital Health
Many providers have been using analytics solutions to identify issues related to claims management for years, and now that same level of insight can be applied to the front-end of the revenue cycle. By providing visibility into eligibility and registration processes and supporting root cause analysis to drive corrective action, patient access analytics can help providers improve point-of-service collections, reduce denials, and support downstream success of all revenue cycle activities.
Jason Williams is vice president of business strategy and analytics for RelayHealth Financial.
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