Applying analytics to patient access can radically improve a health system’s ability to understand what’s influencing financial performance, and improve the metrics that matter.
Some things just go together. Pen and paper. Chocolate and peanut butter. So what about patient access and analytics? Maybe you never thought of bringing them together, but who considered chocolate and peanut butter before it happened? Today, hospitals can make their revenue cycle sweeter by using analytics to improve patient access, and here’s how.
But first, some context.
The use of analytics to improve front-end processes is lagging. KLAS Patient Access research looked at 98 providers’ use of technology to improve billing and collection, and reduce denials. Nearly all (99%) used eligibility verification, followed by patient responsibility estimation (76%), patient address/ID verification (68%), registration QA (66%), and point-of-service collections (56%). Just 34% used performance analytics.1
Perhaps the dearth of investment in analytics reflects a lack of understanding of how analytics can help re-tool revenue cycle for the value-based world. Using data to guide process improvements can drive significant improvements—potentially millions of dollars for a single facility.2 So let’s look at how analytics can help improve patient access, boost registration and eligibility accuracy, and reduce downstream denials.
Denial Management–It's a Reimbursement Thing
After ensuring a quality patient experience, the top patient access priorities are securing correct and timely reimbursement from insurance and from consumers. Their success or failure begins at patient access, making accurate registration/eligibility data (the biggest source of denials) more important than ever.3 Patient access generates vast amounts of data that can be tapped to identify process issues.
Denial prevention and management requires two things: First, new levels of visibility and knowledge of where and why problems originate on the front-end. Are patient responsibilities being accurately estimated? Are estimates being leveraged to drive higher POS collections? What is the overall success rate with patient collections?
Second, prevention and management requires staff flexibility to change processes and workflows to which they have grown accustomed. This is where patient access analytics comes in. The revenue cycle contains many touchpoints, presenting ample room for error. Any attempt to control denials reactively or in an isolated manner will result in inefficient use of staff and a continuing denials issue.
Strategically addressing denials with an analytics-driven approach that drills down into root causes can improve the efficiency of the entire revenue cycle, accelerate reimbursement, and boost overall revenue cycle performance.
Consider one 600-bed health system with denial rates substantially higher than comparable organizations. It analyzed why denials were so high and found that registration and eligibility issues caused problems downstream. Based on that analysis, it targeted specific patient access processes. The related denial rate plummeted from 11.66% to 1.23%. Over four months, that led to $2.4 million in revenue paid on initial submission.4
Pinpointing Front-End Problems
With 30%-40% of denials stemming from registration/eligibility issues, providers need to better understand how patient access processes affect collections.5 Analytics can pinpoint process problems that lead to denials, and reveal how much revenue can be gained through process changes.
Determining correct insurance reimbursement and consumer responsibility at registration are vital to collecting payments down the road. So is securing pre-authorization. Patient-access analytics can even identify when payments should be collected from specific patients–at the point of service, pre-discharge and/or post-discharge–to increase collection rates. Analytics can also show how efficient a patient access workflow is, and identify areas for improvement.
What to Look For
Not all analytics solutions can help with patient access processes. So here’s a capabilities checklist for a solution to help improve performance. Make sure any solution can do the following:
- Analyze data from across your revenue cycle:
- Consumer effectiveness (estimations)
- Insurance effectiveness (authorization, eligibility)
- Team effectiveness (time, cost to collect)
- Standardize data with organization-wide reports
- Offer customizable reports aligned with business processes
- Automatically generate reports on your timetable
- Provide at-a-glance visibility into performance–historical, real-time, and across facilities
Providers have used analytics to flag claims management issues for years, and now that same level of insight can be applied to the front-end of the revenue cycle. By providing visibility into eligibility and registration processes and supporting root cause analysis to drive corrective action, patient access analytics can help providers improve point-of-service collections, reduce denials, and support downstream success of all revenue cycle activities.
1. Patient Access 2014: Assembling a Winning Pit Crew, KLAS Research, 2014
2. Change Healthcare internal analysis
3. Change Healthcare internal data
4. Change Healthcare customer data
5. HBI Academy Research, Registration Errors Significantly Impact Reimbursements
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