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Why Patient Access is Key to Revenue Cycle Management Success

Patient access is the first point of contact for patients and the first time staff can get key information right for revenue cycle management success.

Jacqueline LaPointe
By
Published: 06 May 2021

Patient access is generally the first encounter a patient will have with a healthcare organization, making it central to the patient experience. But this aspect of healthcare is also a major first for another area: revenue cycle management.

During the patient access process, revenue cycle teams have their chance to get medical billing and reimbursement right the first time around. For example, registration is an opportune time to obtain and verify a patient’s demographic and insurance information—important data points needed for accurate and complete reimbursement later.

Through patient access, revenue cycle teams can also clear patients financially for their scheduled services by verifying information and discussing and collecting upfront patient financial responsibility, such as copayments.

All these actions are foundational to optimal revenue cycle management, making it easier and faster to collect patient payments and payer reimbursement. But getting it right the first time is key, according to Sue Plank, director of patient access at Goshen Health.

“From the patient’s perspective, we are the first interaction for their visit,” Plank recently told RevCycleIntelligence. “We have only one chance to make it an exceptional experience. How the patient experiences patient access can impact the remainder of their visit.”

“From the hospital’s perspective,” Plank continued, “our ability to enter the correct insurance, verify accurate demographics for the patient, and collect the patient’s financial responsibility at the front end all reduces rework throughout the revenue cycle, and ultimately reduces potential denials.”

But hospitals rarely have a second chance to get things right not only with their patients but also their providers and payer partners.

Challenges of patient access & revenue cycle

High or increasing claim denial rates can indicate shortcomings of an organization’s patient access workflows. One in four denials stems from registration and eligibility errors, according to Change Healthcare’s 2020 analysis of denial rates. What’s more, the analysis found that about a quarter of potentially avoidable denials cannot be recovered.

Ensuring patient access staff complete registration and eligibility verification are key to preventing some of the most common and avoidable claim denials. But even these tasks can be a challenge for the 30 percent of health systems relying on manual patient access workflows.

“Patient access is transforming,” Plank said. “As patients become more engaged and expectations rise, features like automated and bi-directional communications with our colleagues, better software and technology to increase access to information, and streamlined processes become critical to successful revenue cycle management.”

This was especially true during the early days of the COVID-19 pandemic. At Goshen Health, for example, registering patients while maintaining social distance and quarantine requirements was a major challenge for patient access.

“In early 2020, we were not yet engaging digitally with our patients for any kind of registration, so were quickly looking for ways that we could begin to utilize technology for this effort,” Plank explained. “The stress of this additional coordination created a challenge to our staff and the ancillary areas.”

These challenges only added to the ones patient access teams already face every day, including long patient wait times and constantly changing payer requirements.

Transforming patient access for revenue cycle success

The COVID-19 pandemic was a turning point for Goshen Health’s patient access department.

“The COVID pandemic changed our registration,” Plank explained. “We centralized our outpatient registration efforts into the main lobby. By reducing our walk-in traffic and shifting our colleagues from registration to pre-registration efforts and the implementation of a kiosk, we were able to increase our registration capacity in the main lobby by 55 percent.”

“At the same time, we were able to reduce our patient experience time (registration time plus wait time) by 57 percent. We were able to take advantage of the smaller volumes during the early months of COVID to trial our changes, but these numbers are still holding true a year later as regular volumes have returned,” Plank continued.

Digitally engaging with patients through a single, automated platform has been key to realizing success for Goshen Health.

“Engaging digitally with our patients for patient intake has allowed us to offer contactless registration to our patients which is safer for the patient and our colleagues,” Plank said regarding Goshen Health’s recent implementation of AccuReg’s EngageCare. “It allows them to verify their demographics, take a photo of their insurance card and photo ID, as well as read and sign their consent digitally, all at a time that is convenient to the patient.”

Patients have quickly taken up the health system’s “digital front door,” which also includes digital appointment reminders, COVID-19 screenings, and check-in options. In fact, Plank has observed early adoption rates of 45 percent.

But the digital patient access and engagement tool has done more than improve patient experience. Point-of-service (POS) cash collections, for example, have also increased by 38 percent in the first quarter of 2021 compared to the same time the previous year. And this is resulting in lower overall cost to collect for the health system.

Another cost-saver was appointment adherence. “Although our implementation was recent, we have already seen some reduction in our no-shows, which links directly to our ability to protect our revenue,” Plank stated.

The digital transformation at Goshen Health was able to alleviate many of the pain points of patient access—long wait times, inaccurate data capture, and no-shows—but it also helped to strengthen relationships between all the players involved in a patient’s healthcare journey.

“I didn’t realize how much implementing integrated patient access, intake, and engagement technology would heighten our awareness of inefficient processes,” Plank stated. “This implementation provided us an opportunity to collaborate and significantly improve our processes and communication with each other and provide more consistent communication with the patient.”

Plank plans to bolster this collaboration through “expanded automation and visibility between patients and hospital staff to ensure a consistent patient experience and high quality of care.” The patient access leader is also looking into mobile payment estimates and payment to further increase POS collections and “make consumerism a reality for” patients.

But data integrity will be key to revenue cycle management success as patient access evolves.

“As we transition to a model where the patient is performing some patient access tasks historically handled by the registrar, it is critical that we have a solution that ensures data integrity, otherwise there will be a negative impact on net patient revenue for our hospital,” Plank said.

Integrating traditional patient access tools with digital intake and engagement is the solution for protecting the bottom line while improving the patient experience.

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