Patient Access – Strong Foundation Leads to a Stronger Revenue Cycle

Patient access service is a core function of the revenue cycle. It also serves as the first point of contact or a patient's entry point to the health system and is a crucial part of the patient experience. It is vital to get it right the first time, as missed appointments come at a cost.

Setting up a robust patient access process is important because:

• In the US alone, missed appointments cost the industry an astounding USD 150 billion every year. A typical health system risks up to 3.3% of its net patient revenue because of claim denials—that is approximately USD 4.9 million per hospital on an average. The analysis also found that ‘registration or eligibility’ is the leading cause of denials (23.9%), followed by ‘missing or invalid claim data’ (14.6%). Another analysis done in 2020 suggests that one in four denials stem from registration and eligibility errors. A quarter of these avoidable denials cannot be recovered.
• In January 2021, the Center of Medicare and Medicaid services (CMS) finalized a rule on electronic prior authorization. The rule requires certain payers, providers, and patients to have electronic access to pending and active prior authorization (PA) decisions, and other data about whether a treatment cost will be covered by the payer. Better data sharing will improve transparency for providers, payers, and patients.

These data points emphasize the importance of ensuring accuracy to prevent rework and denials. Capturing the key information properly the first time determines the success of the revenue cycle management process.

The benefits of an improved patient access process are as follows:

Ensuring ease of access

Provide multiple technological access points that connect patients and providers to the health system, such as IoT, email, and mobile applications among others. This improves interaction and allows patients to easily find and access the care they need. Such technology allows the health system to personalize communication between the patients and care givers, and seamlessly integrates registrations, appointments, cancellations, and rescheduling.

Transforming scheduling and simplifying referrals

One aspect that can assist and improve healthcare outcomes is appointment reminder services. This will reduce no-shows and last-minute cancellations. Automated reminders on upcoming appointments or pending payments keep patients updated and help providers focus on patients’ health. In addition, the referral process must be made easy for both physicians and patients. One approach is to establish processes that proactively help patients make referral appointments, engage with them to answer questions, and make sure that they follow pre-procedure instructions. Key steps in the referral process—like prior authorization of services—should be examined for potential automation to drive efficiency and reduce burdens on providers and patients alike.

Offering patient-centered care

Patient-centricity—a key focus of the healthcare industry—needs to be a pivotal component of the patient access solution. With the technology that delivers focused information at the right time, patients can plan their visits at their convenience.

Delivering key insights

Data analytics can help identify opportunities for improvement, offer visibility into the eligibility and registration processes, and support root cause analysis to drive corrective action. With analytics, providers can improve their point-of-service collections and reduce eligibility or authorization denials by 25%–30%. This lays a strong foundation for increased efficiency and success of the downstream revenue cycle process.

Optimizing the revenue cycle performance

Integrating the patient access operations can optimize resources, enhance patient care, and increase revenues. To achieve this, it is necessary to:

• Identify and educate patients about the payment plans and options. This will ensure that a major part of patient responsibilities is looked after.
• Employ and leverage domain experts to improve performance efficiency. Additionally, implementing new technology will improve accuracy.
• Make data interoperability a priority for data sharing between the stakeholders.

 Using technology to enhance patient experience

Patients are enthusiastic about new technology, including automated digital communication. Reassessing and syncing traditional patient experience models with technology enables creation of a care continuum; one that engages and personalizes every touchpoint of the patient’s journey.

Artificial intelligence (AI)-powered chatbots offer patients ease and convenience. Access to personalized care is now possible. These user-friendly chatbots track and guide the patients based on the conversation. Health systems and care providers must leverage chatbots for patient engagement and customer service.

The combination of patient-first approach and the right technology solutions can create a seamless experience   for patients and providers. An effective patient access service improves patient satisfaction and ensures an efficient revenue cycle.