Today’s hospitals and their healthcare providers are under inordinate pressure to do more with less. In this guest post, Shawn Yates, director of healthcare product development at a software company, offers three ways hospitals and healthcare providers can keep patients happy, stay compliant and collect revenue without sacrificing care.
The need for healthcare services hasn’t diminished, but providers are struggling to meet the demands and regulations inflicted by recent policy and legislature.
Medicare reimbursements are lower, there are new federal regulations that result in bundled payments and there’s a threat to take away the employer health exemption. In addition, with the election of a Republican President and full control of the House and Senate by the GOP, radical changes are certain with the Affordable Care Act. Providers are looking at near impossible pressures to keep margins positive while producing the same high quality patient care.
In order for providers to meet the gap, healthcare networks are turning to mergers and acquisition (M&A) agreements – hospital M&A activities jumped 70% within the last five years. For smaller providers, M&As equate to access to resources like higher levels of technical capabilities for both patient care and corporate processes, like revenue recovery.
This is a critical area for most providers and networks as, in most cases, a manual process just won’t cut it any longer. Here are three ways to satisfy patients, stay compliant and collect revenue without hurting patient care or employee productivity.
1. Patient satisfaction
The most important mission for most healthcare providers is to provide the best care possible to patients. But, when pursuing more complete patient satisfaction, that’s only part of the equation. Providers should rely on a centralized platform, particularly in this era of growing patient self-pay, to carry out essential patient satisfaction functions.
Segmenting accounts through a centralized platform allows providers to use contact management technology and multi-channel data to personalize patient information. They’re better able to determine patient preferences and self-service options, among other important information. Patients’ needs are met as communication is delivered through the channel of their choice and with 24/7 online access.
Combining data from all available sources seems like an easy task, but with the complexities of many providers, it can be impossible. A centralized platform creates a more accurate information source, fewer bills to the patient, and a singular, positive experience for patients, lowering their stress.
The majority of healthcare expenses tends to be unexpected. A horrible accident or diagnosis can devastate a patient’s finances. Because of the unexpected nature, many patients struggle to pay their full medical expenses. As a part of that data and personalized patient profile, providers can have ready access to patient’s insurance information, including missing insurance, and what financial assistance options may be available. Being able to look at every form of reimbursement available, as well as those payment/ finance options, will not only alleviate the personal financial burden for patients, but will increase both payor reimbursement and patient satisfaction.
2. Internal process betterment
As mentioned above, siloed information can create numerous issues for patients. However, it can also cause plenty of pains for internal staff members, such as lower productivity, slower response time and time to reimbursement, as well as an increase of insurance claim denials.
Clerical errors can, understandably, become more commonplace with overworked administrative workers in healthcare. Remember that “doing more with less” mentioned earlier? Staff members have to work just as hard often with fewer available resources. By automating many of these more routine processes, staff members can lower their risk for human errors and better focus their time on more challenging accounts and cases.
This level of automation isn’t unusual in other parts of the system – it already exists within many facilities. Claims and remittance technology that requests information without manual input is already used. By this simple implementation, providers are seeing major benefits in accuracy, efficiency and reimbursements. In fact, they’re reporting up to 80% resolution with a single transaction.
Automated claims status activity can also generate exception-based workflows that offer their own set of benefits. Detailed work processes can raise productivity and quality assurance, encouraging smarter work over harder work. Those processes include combining disparate key claim adjustment reason codes into subcategories to assist with follow-up, and using it in dashboards and other reports to hone in and solve potential problems before they actualize. This helps staff boost productivity and drive the best, most informed business decisions.
3. Staying compliant
Regardless of the centralized platform or technology you choose to implement, it must stay compliant with federal and industry regulations.
One of the best ways to make sure the technology implemented provides both workforce productivity improvements and keeps the provider fully compliant is with dedicated personnel. These staff members will train and continuously check the pulse of customer service staff.
Providers, during revenue recovery processes, have to adhere to many regulations. Most are familiar with HIPAA and how to remain HIPAA compliant in all activities, but they must also keep in mind regulations dictated by the Telephone Consumer Protection Act (TCPA) and Unfair, Deceptive, or Abusive Acts or Practices (UDAAP) guidance from the CFPB.
Thorough compliance audits with annual reviews, allow accurate reporting to executive level leadership. It also means providers can focus on areas of improvement, while also ensuring the necessary processes and personnel are in place, making sure the technology can start immediately solving issues.
To provide top-tier care to patients, facilities need to recover revenue. One of the best ways to do so is implementing the latest technology available. The healthcare industry innovation and change isn’t slowing down. Hospitals and their providers need to be one step ahead, using the best available options to streamline workflow, satisfy patients and maintain compliance. With those tools, they can provide the best care keeping patients, and their bottom lines, healthier.
Shawn Yates is the director of healthcare product development at Ontario Systems.