Five Steps to Capture Lost Revenue for Hospital Outreach and Outpatient Services

This blog post is the final installment of our five part series. View Part One, View Part Two, View Part Three, View Part Four.

Pressure on hospitals and health systems to promote transparency, access, and engagement for patients and physicians is accelerating on multiple fronts. For example, as of January 1^st 2021, CMS requires hospitals to post specific pricing data for at least 300 “shoppable services” in both machine readable and consumer friendly formats. Data must include gross charges, discounted cash prices, payor-specific negotiated charges, and de-identified minimum and maximum negotiated charges. 

Beyond regulatory requirements, multiple studies demonstrate both the consumer demand for — as well as the economic benefits of — better patient engagement with greater pricing transparency:

Better physician engagement tools can directly impact bottom line results as well. By automating key front-end aspects of the revenue cycle, for example, a physician portal can help streamline client engagement into a paperless process. Benefits include avoiding and correcting costly errors, accelerating information exchange (e.g., order entry, test information, pricing), and speeding reimbursements.   

To summarize, improving stakeholder access and engagement, with emphasis on providing out-of-pocket cost transparency for patients and process automation for physicians, is no longer negotiable.

A start-of-the-art revenue cycle management solution should offer a full complement of patient and client engagement capabilities to facilitate this strategy.

For Patients:

• Patient responsibility estimation: provides patient responsibility amount using real-time information
• Pre-payment acceptance: enables collection of pre-payment and can store payment information for future transactions
• eBills & notifications: provides optional paperless billing and/or email or text notifications
• Optional payment plans: giving customers greater flexibility
• Courtesy letters: for introductory communication before sending a statement, helping improve the patient experience
• Integrated Voice Response (IVR): helps serve patients by phone with outbound calls and inbound call routing and interactive services (including payments)
• Self-service portal: offering 24/7 access and information exchange, including insurance details and test results

• Reduce errors, lower costs, and help large practices become more efficient through automation and paperless processing
• Reprocess claims with billing errors or incomplete information faster
• Avoid “timely filing” denials and delays
• Accelerate reimbursement
• View test information and pricing
• Identify repeat offenders – i.e., those individuals with more errors, incomplete billing data, or orders outside of medical necessity guidelines
• Upload documents, such as for prior authorization
• Perform order entry
• Conduct patient eligibility checks
• Access clinical decision support
• Examine statements at the line-item level
• Self-service portal: providing 24/7 access and information exchange

Want to explore how front-end RCM automation, enhanced denial management, insightful analytics, universal RCM compliance, and better engagement can help your hospital? 

Sources:
1. MedData 2021 Medical Billing Statistics.
2. The Advisory Board Company What Do Consumers Want from Primary Care?
3. TransUnion COVID-19 and Economic Impacts from Pandemic Driving Increased Focus on Health care Consumerism