Automating Patient Financial Clearance Cuts Denials, Boosts Payments

Patient financial clearance is meant to provide a seamless patient experience while ensuring a smooth revenue cycle for providers. But more often than not, the process can be drawn out, burdensome, and even result in barriers to care delivery.

At least that was the case at South County Urological in Missouri before a workflow automation tool streamlined the process for the three-physician specialty practice.

“Being a specialist office, there are referrals many of the times. We also have a lot of managed care plans in our area here,” Theresa Hammack, officer manager at South County Urological, recently told RevCycleIntelligence. “Many times, patients were sitting at the front desk because a referral was supposed to come and it never did. There wasn’t good follow-up to verify that it was received before the patient arrived.”

Like many practices, South County Urological was using what Hammack called an “antiquated process” that was “very manual,” which resulted in potentially avoidable denials, longer patient wait times, and ultimately more work on the back end of the revenue cycle.

“We would have to print schedules and work off of those to verify insurance and obtain referrals,” Hammack used as an example. That is, until the practice decided to automate workflows to make sure they could clear patients financially before the appointment.

“We knew we wanted to make improvements. We're always trying to be more efficient. One of the ways to do that was to try to streamline a very antiquated process. So, we were thinking that we needed to spend less time doing this and making sure things weren’t falling through the cracks in our antiquated system.”

Leveraging capabilities in its practice management platform from MedEvolve, South County Urological implemented dashboards outlining the information and tasks needed to be done before a patient even stepped into the office, including referrals and updated insurance information.

“A lot of that stuff was being done once the patient was standing in our waiting room. At that point, it's a little late and it just bogs down the entire system if we're waiting for things at the front desk,” Hammack said. “[The software] enabled us to get everything done prior to the patient ever coming to the office. So once the patient does arrive at the office, we can just focus on their healthcare needs at that time because everything else is done. It helps the entire flow of that patient encounter from start to finish.”

With workflow automation, staff at South County Urological are overcoming the challenges of the referral process, which hinges on the actions of other practices and providers.

“What this system enabled us to do is see if a referral has arrived or if it hasn't arrived. I can look at a dashboard and it's going to tell me what I'm waiting for, if anything,” Hammack explained further. “So that if it's now the day before the patient gets here and I still don't have a referral, I need to make a decision. Do we have to reschedule because the primary care provider is not going to issue it? What's the next step that we need to do so when the patient does get here, we're able to serve them?”

Workflow automation also ensures staff are verifying demographic and insurance information, any prior authorization needs, and a patient’s financial responsibility days before the patient arrives for his appointment. The last benefit has particularly improved revenue cycle management.

Patient financial responsibility has steadily increased over the last decade, with the most recent increase being 12 percent according to 2018 data from TransUnion Healthcare. For providers, this has slowed the revenue cycle as three-quarters of providers report patient collections taking over a month when bills are over $1,000.

A couple of days before a scheduled appointment, staff call the patient to verify demographic and insurance information, as well as discuss patient financial responsibility.

“We collect our copays prior to the patient arriving, so any copays, any prior patient balances, we collect during that phone call that we make,” Hammack stated. “So that has really helped increase our point-of-service collections from prior to going automated to now by about 300 percent.”

At the same time, patient payments also increased by 15 percent and coordination of benefits (COB) denials decreased by about 75 percent.

“Denials are down because we’re doing so much homework on the front end,” Hammack explained. “We’re not having to go back and make corrections. Sometimes insurance information isn’t entered correctly. The system will tell me that. I’ll know if things aren’t right before I send that claim out.”

“It’s just so much easier to do everything on the front-end than trying to go back later and sort it all out. That holds up the entire reimbursement process.”

Claim denials are also on the rise and most of these denials are potentially avoidable, especially with front end revenue cycle improvements. Data from Change Healthcare shows that 86 percent of claim denials are potentially avoidable and specifically, one in four denials stems from registration and eligibility.

But the revenue cycle is not the only area seeing improvements from automation. Patient experience is also improving because of the streamlined process.

“When they come to our office, there aren’t hold-ups at the front desk anymore,” Hammack stated. “We’re not sitting there waiting for their referral to come in or whatever the case may be. All of that is done. They’re not filling out extra paperwork. They are just sitting there waiting to see the doctor.”

And now that practices have managed parking lot waiting rooms, telehealth, and other socially distanced check-ins with patients, patient financial clearance automation has a lot more potential.

“We moved to this system prior to COVID hitting, but once COVID did hit and it was as bad as it was, this was a game changer for us,” Hammack said.

Workflow automation enabled the practice to go through patient financial clearance days prior to the appointment, eliminating the need for unnecessary contact for paperwork or other items. With telehealth here to stay, workflow automation could be the solution to the challenges of checking patients in when they no longer need to leave their house to get quality care.

“Work with your vendor to see what kind of enhancements or enrichments that they can provide because you’re only going to be as successful as the software that’s going to be bringing this all front and center for you,” Hammack advised those who may be needing an automated patient financial clearance workflow now.

And don’t wait, Hammack added. “The biggest thing we learned is that we really should have done something like this a long while ago.”