Ease the squeeze with data automation. Improving patient’s financial journey can increase revenue and reduce expenses
By John (JD) Donnelly, CEO, FrontRunnerHC
Revenue cycle management in today’s environment is tough. Providers are getting squeezed with decreasing reimbursements and increasing expenses, leading to shrinking margins that impact success. With pressure from both sides – as well as the pressure of consumerism, it’s critical that providers get paid for the services they deliver while also ensuring their patient’s financial experience is as positive as their clinical experience. The reason it’s so critical is because, as we often say, the Patient Experience = Clinical Journey + Financial Journey™. But ensuring that the patient’s financial journey is a positive one is easier said than done when you consider all that’s involved.
While the patient’s financial journey will vary depending on the type of organization, one thing is constant. From the moment a patient is registered to the time the claim is paid, there are challenges that jeopardize both the provider’s ability to get reimbursed and their patient’s experience. For many of our lab clients, as an example, the high-level steps that might impact their patient’s financial journey are listed below (along with a primary goal we help them achieve at each step):
Patient Registration: capture accurate patient information
Specimen Collection: provide smooth process for onsite or at-home testing
Cadence Management: ensure everyone is accounted for during testing
Test Results: communicate test results via SMS or email
Compliance: verify patient’s test results for entry to flights, events, work, etc.
Claims Process: expedite claim submission to patient, payer, or government
Payment: expedite payment collection and understand patient’s propensity to pay
So what can go wrong along the patient’s financial journey? Actually, this article isn’t long enough to go into all the possible problems that can occur along the way, but you can get a glimpse of them in our graphic below. The conversations we have with labs and other healthcare organizations about their patient’s financial journey are always interesting. Most healthcare leaders we speak to find themselves nodding in agreement as we talk about this journey and the challenges en route.
The root of many of the issues? Bad data: missing, incomplete, or inaccurate patient demographic, insurance, or financial information. One common problem, for starters: the patient’s insurance changes between the time they’re registered and their lab test, so the insurance information in the system is invalid. And with more people changing jobs these days, the more insurance plans are changing as well. This means that when collecting the specimen, your lab or sales staff often must manually call the physician office to track down the correct information… something that neither your staff nor the physician enjoys.
Suffice it to say, the patient’s financial journey can get pretty bumpy. And those bumps are felt by many: the patient, the referring physician, and your organization.
But the news isn’t all bleak. By leveraging data automation technology, providers can quickly tackle the problems or better still, stop many of them from happening in the first place. They can capitalize on opportunities to manage their costs, address volume fluctuations, and get paid faster while enhancing their patients’ experience.
At the Executive War College conference, I had the pleasure of presenting with our client, Nichole Kerr, Director of Revenue Services at Sonora Quest, on this important topic. Sonora Quest is a great example of an organization who is leveraging data automation, and we’re honored to collaborate with them.
During the presentation, Nichole referenced the 2020 CAQH Index which reported that automation had resulted in efficiency savings of $122 billion for the US healthcare system in 2020. And yet, as she also pointed out, an estimated one in four providers still aren’t leveraging data automation in their revenue cycle workflow.
Nichole shared her team’s experience and some of the results Sonora Quest has attributed to implementing data automation, like:
Days sales outstanding (DSO): decreased 10-13 days
Cash collection: more stable with 103.7% collected vs. goal
Increased capacity to prioritize and resolve “at risk” unbillable accounts receivable (AR)
Write-offs due to claims being too old to bill declined 7%, saving $1 million
Outgoing missing information letters: decreased 12-13% annually
Outgoing service and postage costs: decreased 13% annually
Improvements in patient satisfaction measures:
Abandoned Calls decreased by 65%
Call Service Factor improved by 28%
Patient Call Volumes decreased 19%
(For more info on Sonora Quest’s experience, check out: https://www.frontrunnerhc.com/post/client-success-sonora-quest-laboratories)
Quickly collecting reimbursement for the services you’ve provided while keeping a positive patient experience has never been a higher priority. Data automation can be leveraged anywhere in your patient’s financial journey – front-end, back-end – wherever it makes the most sense in your process. Consider how data automation in today’s environment can not only help you survive but also ensure your long-term sustainability and growth.
If you’re interested in talking about how data automation may help your organization, reach out to me at john.donnelly@frhc.com. I’d welcome the discussion.
©FrontRunnerHC, 2022