By John (JD) Donnelly, Founder & CEO, FrontRunnerHC
Lab testing is the cornerstone of healthcare with an estimated 70% of medical decisions informed by lab results. Yet, it’s also been estimated that about 30% of lab tests ordered are inappropriate or unnecessary. Think about the amount of time and money wasted and, even more importantly, the delays in patient care that inappropriate lab tests can trigger. One of the root causes of wasted time, money, and care delays? Inaccurate, missing, or incomplete patient information. To quote the American Academy of Family Physicians from the FPM Journal: “To take care of your patients, you need to know who they are.”
At FrontRunnerHC, our mission centers on ensuring our clients have instant access to the information needed to answer the question “who is the patient?”. This seemingly simple question is one filled with complexity and challenges. Within labs and healthcare organizations, bottlenecks build due to a lack of transparency of current patient insurance, demographic, and financial information, as well as info related to medical policy adherence that helps determine if a test or service will be covered by insurance.
That’s what makes us so passionate about the pursuit of what we call a Super-Clean Order, one that not only includes accurate patient information but also ensures the ordered test will be covered by insurance and the patient gets the care they need. Given the importance and complexity of lab testing, we think it’s imperative that a Super-Clean Order becomes the norm, not the exception. It’s vital to the sustained success of healthcare organizations and critical to a positive patient experience, both clinically and financially.
We understand the challenges faced by physicians, labs, hospitals, payers, and most importantly patients when it comes to getting all the necessary clinical and financial patient info upfront to ensure the best outcomes possible. To help achieve a Super-Clean Order, we are collaborating with organizations across the healthcare continuum to break down the traditional silos and enable transparency of the needed info prior to the test being run or service rendered. Disruption of the healthcare status quo is challenging but important. Without it, the risks are too high: unreimbursed services, write-offs, spiraling costs, inherent inefficiency, unnecessary tests, care delays, & confusing patient bills. Transformation benefits everyone involved, especially the patient.
We often say the patient experience = the clinical journey + the financial journey. The intersection of clinical care and the billing experience is becoming more and more critical to the patient’s experience, especially as the industry shifts toward value-based care.
Delivering quality patient care is the highest priority for a healthcare organization, but our healthcare system is always changing and growing in complexity. A recent MGMA report that polled medical practices found an “uptick in regulatory burden is diverting time and resources away from patients” and “97% of respondents said reducing regulatory burden would allow them to reallocate resources to patient care”. They also noted that the regulatory burden included prior authorization. We are helping organizations address the complexity and eliminate obstacles that threaten both reimbursement and the patient experience with transparency of the info needed to enable dialogue and informed decisions.
We leverage the power of automation to help address the challenges for labs, providers, hospitals and health systems, and billing companies – and ultimately, the patient. Embracing automation to reduce manual and time-consuming tasks can significantly improve efficiency, allow staff to focus on other priorities, and bring more dollars in the door faster. KLAS reported that “revenue cycle leaders at top healthcare organizations are prioritizing automation”.
The report also stated “healthcare organizations are seeing the most return on investment (ROI) from automation of claims management tasks.” With eligibility and registration the number one reason for claims denials and authorization/pre-certification issues and ‘service not covered’ the next two reasons, we are working with clients to rethink their workflow to find and fix problems before they start, by accessing the info they need at the front end.
Our data automation solutions can be integrated with your LIS or billing system, and our team of experts can tailor the software to meet your needs and optimize your workflow. As patients move through the care journey, it’s fundamentally important to capture correct patient information and access it at any point on demand, especially if that information changes -- which it likely will. We provide accurate patient info – at order entry or anytime during the lab accessioning process – in realtime or in batch if preferred. Our capabilities include:
Lab order entry - capture clean patient info at intake with tailored ask-at-order-entry (AOE) questions
Demographic Verification – capture and verify patient’s demographic and contact information
Eligibility Verification – verify patient insurance eligibility and find secondary insurance plans
Insurance Discovery – find missing insurance and fix insurance information errors
Pre-adjudication – help you comply with medical policy and streamline the prior authorization process
Accession Routing – determine the optimal place to run the test with visibility into the information needed
Financial Disposition/Propensity to Pay – optimize collections while considering each patient’s specific financial situation
Patient Results Delivery – allow patients to view results, order direct-to-consumer tests, and make payments online if applicable
Our goal is to help fuel our clients’ success by driving tangible results. Sonora Quest Laboratories, a long-standing client, recently calculated a 25:1 ROI, leveraging our software to help them get paid faster, reduce write-offs, and cut expenses, among other impressive results. And we were able to help a new client – a regional clinical lab in the Midwest – recognize an incremental ~$6.8 million revenue opportunity by quickly finding that 61% of the patients submitted had active coverage – info that was previously unknown and was immediately actionable.
We know how critical labs and healthcare organizations are to our communities and the importance of a lab test. There is no room for wasted time, money, or care delays. By enabling you to instantly harness accurate patient info, you will know with confidence “who the patient is”, empowering you to take care of your patients, your staff, and your bottom line. Together, we can transform healthcare and provide the best experience possible for all patients.