MedHealth Outlook
September 13, 2022
Though the healthcare sector is often considered the backbone of the country, it’s far from perfect. While there are many opportunities for improvement, one area in need of strengthening for most labs and healthcare organizations is their bottom line. Without a strong bottom line, their ability to provide care to patients across the country is jeopardized. With declining reimbursements and growing expenses, it’s a constant
concern for many. According to the New York Times, there was an estimated $140 billion in unpaid medical bills held by collection agencies last year – and that doesn’t count the amount of unpaid bills in pre-collection status. This leads some organizations to aggressively pressure patients for payment while it leads others to take write-offs to avoid potentially upsetting patients and losing future business from them or their referring physicians.
But there’s a better way to both increase revenue and provide a positive patient experience at the same time, according to John (JD) Donnelly, Founder and CEO of FrontRunnerHC (www.FrontRunnerHC.com), a leading SaaS solutions provider for revenue cycle management (RCM). “The healthcare ecosystem is often out of balance,” Donnelly says. “I think of it like a pendulum. If healthcare organizations try to increase reimbursements by applying pressure in the wrong way, it can drive down patient satisfaction which can negatively impact physician referrals and repeat business. We encourage our clients to take a more balanced approach, leveraging data automation to improve their bottom line as well as the experience for their patients and referring physicians.”
Working with several hundred clients across the country, Donnelly understands the challenges that threaten reimbursements and the patient experience, and he understands the key cause of many of those challenges: bad data. Missing or incomplete patient data leads to rejected claims, lost revenue, physician and patient dissatisfaction, costly rework, and staffing constraints. Getting the right patient demographic and insurance information is harder than you think for healthcare organizations, especially with people constantly moving and changing insurance plans. According to an article by Axios, it’s reasonable “to estimate at least 2 million workers and their families lose or transfer to new commercial health plans every month.”
Solutions to Zero in on the Problem
Donnelly and his team have developed a platform of data automation solutions that zeroes in on the problem, and their 2-week product development sprints drive constant innovation to help stay ahead of the dynamic market. By instantly serving up accurate patient insurance, demographic, and financial information exactly when and where their clients need it, FrontRunnerHC enables them to address the challenges fast – or avoid them altogether. “We have built the technology to fix the patient information before the patient even gets the bill so the patient is happier and more reimbursements are collected faster,” says Donnelly.
That’s good news to organizations whose bills often go unpaid. Moreover, it’s good news in light of the growing consumerism, with patient expectations rising daily and yet often going unmet. Examples of patient dissatisfaction can be easily found in surveys indicating frustration, confusion, and surprise related to medical bills.
With complete and up-to-date patient information, healthcare facilities can automate and expedite their workflow and allow their staff to focus on more value-added efforts. Without it, the problems persist and multiply throughout the process, driving up operational inefficiencies and expenses and putting patient satisfaction and revenue at risk.
FrontRunnerHC helps organizations combat the issues that arise throughout the patient’s financial journey – from patient registration through bill payment – by putting clean patient insurance, demographic, and financial information at their fingertips. While they encourage clients to leverage their solutions upfront to capture the patient’s data and fix any errors right away, clients can choose to use them anywhere they want in their process including on the backend. The information is accessible instantaneously on demand (realtime) or in batch – whatever the client prefers. Because patient information frequently changes from the time of scheduling to their appointment as they may move, switch jobs, or change insurance plans, FrontRunnerHC suggests accessing the data “as early as possible and as often as needed” to help catch any changes and avoid forfeiting reimbursement.
One of FrontRunnerHC’s flagship solutions within its portfolio is PatientRemedi®. The software finds, crosschecks, and even fixes patients’ demographic and medical insurance information (including coordination of benefits (COB) coverage for MCOs & Medicare Advantage Plans), and can automatically post the correct data back into the client’s existing system if they would like. This data helps healthcare organizations ensure claims sent to payers or patients for reimbursement are right the first time for the highest clean claims rate. “Our network of payer connections which is extensive and constantly growing enables us to instantly access federally regulated data to find upto- date patient info, enabling touchless clean claim submission and expediting reimbursement,” explains Donnelly.
From the patient payment perspective, a good strategy, per Donnelly, is having the ability, on demand, for authorized users to understand a patient’s unique financial situation and likelihood to pay. PatientRemedi provides relevant financial information about the patient that helps healthcare organizations make decisions that are best for both the patient and them. Using the software to gauge patients’ propensity to pay and determine financial disposition strategies, lab and healthcare administrators may choose to offer payment plans, prompt pay discounts, or even hardship discounts to patients who fall under the Federal Poverty Line (FPL) and who may have otherwise postponed care due to affordability issues.
While the tools can benefit patients, they can also help improve an organization’s collection strategy. Marrying patient financial information obtained via PatientRemedi with historical patient collections data provided by the client, FrontRunnerHC can see where clients have been most and least successful in collecting from patients and recommend and execute operational changes to maximize future collections. One large genetic lab client recently saw patient payment collections increase by 8% within 30 days of the first bill by leveraging the software. Using insights from the tool, organizations might also choose to send a collection agency only the past-due accounts for patients who have a low likelihood to pay rather than sending them all past due accounts and focus in-house efforts on the others.
Donnelly emphasizes that the answer to increasing healthcare collections isn’t necessarily sending more bills and making more calls. That approach, he says, can backfire, creating patient dissatisfaction – and add more work for staff who is most likely already stretched thin.
“To increase reimbursements, patients must be at the center of an organization’s revenue cycle strategy,” says Donnelly. He encourages they create a patient-centric experience from beginning to end, provide the patient a good estimate of their expected costs including knowledge of what’s covered, and get them an accurate bill that aligns with the estimate and their financial situation once the service is provided – or better yet, at the time of service.
“Super Clean Order leads to a Super Clean Claim”
Capturing accurate patient data up front at order entry when a healthcare service or lab test is scheduled is ideal in helping to create a patient-centric experience. FrontRunnerHC is working with more and more organizations daily who see the value of catching and fixing problems early by cleaning the data at the front end to drive a better patient experience. And with insurance eligibility and registration issues the #1 reason for claims denials according to an article featured in MGMA, it can also reduce denials, inefficiencies, and expensive rework.
“With so much pressure on organizations, they don’t have time or money to waste manually fixing patient information errors which I’d estimate is a factor in about one-third of claims prior to submission. We are providing tools so labs have clean patient data before it goes into their system. A super clean order leads to a super clean claim,” exclaims Donnelly.
LabXchange®, the company’s vendor-agnostic electronic order entry system, helps labs expedite the time needed to collect and process tests. And it also enables them to communicate directly with patients when results are ready and allows results to be viewed instantly.
The Power of Partnership
Leveraging the vast expertise of its team – many of whom have walked in the clients’ shoes, FrontRunnerHC takes a consultative approach as it partners with clients, helping them optimize each solution to navigate the industry challenges and achieve their specific goals. Moreover, the company continually innovates their technology, collaborating with clients, partners, and other industry experts to ensure clients have sustainable solutions with a competitive edge. “The industry looks to us to drive change and always be innovating on ‘the next big thing’. We’re constantly focused on enhancements and new solutions that create a better experience for our clients and their patients,” Donnelly comments.
A pioneer in delivering cutting-edge revenue cycle management and medical billing software, the company’s 2-part mission to help clients improve their bottom line while enhancing their patients’ experience is being accomplished. Donnelly shares many instances of assisting their clients. In one example, he talks about partnering with a large lab that handles about 35,000 patients a day. “Collections went up significantly because of the solution and patient satisfaction went through the roof.” He adds, “We focus on our clients’ goals and celebrate their success. In fact, our Million Dollar Club recognizes clients who have uncovered over a million dollars in revenue in a calendar year with our software. In 2021, almost a third of our clients uncovered anywhere from $1 million to over $90 million.”
Redefining the Future
Today, with numerous awards and success stories already on the list (including Inc. magazine’s list of “America’s fastest-growing private companies” for four years in a row and Inc.’s recent list of “America’s Best Workplaces”), FrontRunnerHC has no intention of becoming complacent.
Donnelly launched the company in 2010. Early in his career, he worked with insurance companies and industry stakeholders to establish data standards and automation technology to support the electronic transmission of patient data for insurance billing. His commitment to collaboration, agility, and innovation – what he refers to as the core pillars of the FrontRunnerHC culture – has never wavered.
It is Donnelly’s unrelenting passion with the blend of his expertise that fuels the team’s success and their ability to continually empower healthcare facilities and labs. While the healthcare space faces increasing challenges, FrontRunnerHC is driving positive change with connected and automated solutions.
“We’re always working to positively transform healthcare in ways that most people haven’t even thought about,” says Donnelly. “Too often, insurance companies, healthcare facilities, labs, physicians, and patients are in silos. When I think of the future of healthcare, I see a fundamental change in how billing and testing occurs. We are working with all of them to break down the silos for a more cohesive and integrated ecosystem where everyone wins,” concludes Donnelly.
Original article featured in MedHealth Outlook