Defining the evolving role of Patient Access

By nThrive | Posted: 01/23/2018

The term “Patient Access” is often used broadly to include such barriers for care as lack of insurance coverage, high deductible health plans and financial limitations, however it is also what health care organizations traditionally call the front-end operations of their revenue cycle. As the first point of contact, Patient Access begins with the initial encounter, where staff confirm patient identity, verify insurance coverage, provide estimates for ordered services and more.

With health care reform, the complexity of Patient Access has evolved substantially, putting more focus both on staffing requirements and accuracy of information. The National Association of Healthcare Access Management (NAHAM) defines a long list of general responsibilities, including everything from custom service to verifying accurate and complete patient information and collecting out-of-pocket expenses.

Much focus is being put on streamlining and improving the performance of the Patient Access department, as accuracy on the front end is proven to help reduce bad debt and denials after the fact. Technology is a key enabler, automating information collection and giving providers visibility into insurance benefits and other key sources of information.

Use of technology is especially valuable in helping organization’s provide accurate estimating, which is required by law in many states to help patients make more informed decisions on their care choices. Advocacy services are being incorporated to provide counseling and assistance, especially to help the uninsured population obtain payment through Medicaid and other charity programs.

Health care organizations are also extending Patient Access into ambulatory settings to enable one-call resolution on patient issues and other services.

For a more in-depth discussion on changes impacting the front end of the revenue cycle and how you can stay ahead of the curve, read our recent blog, “Navigating Patient Access in the new age of health care,” by Kelley Blair, nThrive senior vice president and general manager and Erica Franko, principal, nThrive Business Health.