To improve financial clearance and reduce costs, consider expert help

By Brett Palmer, Senior Vice President, Front & Middle Services Delivery | Posted: 07/20/2018

Reduce Denials

If you walk into the Patient Access department of a typical U.S. health care organization, you’ll likely find multiple full-time employees fulfilling a range of functions, from scheduling and registering patients to taking calls – all in addition to their financial clearance responsibilities. Over the course of a day their time is often divided any number of ways, potentially impacting everything from productivity to the accuracy of patient health information.

One way health care organizations can significantly improve financial clearance efficiency and reduce operational costs is leveraging expert external resources to offload such tasks as verifying health insurance eligibility and benefits, address and identification (ID) verification, medical necessity, propensity to pay and more.

Less distraction enables staff to better manage the initial patient experience, reducing patient registration wait times and improving patient satisfaction. Having external support on financial clearance also helps to reduce denials from information errors and improve cost to collect revenue from higher point-of-service (POS) collections.

Clearing patients status earlier

For most hospitals, financial clearance is akin to being caught in a rat race. In most instances, it is all Patient Access representatives can do to clear same day, next day patients versus working farther out on elective cases. However, because an estimated 70 percent of patients are scheduled out in time for elective procedures, this makes it possible to clear them much earlier.

Clearing patients sooner rather than later facilitates better planning for everyone involved. Health care organizations have time to ensure all information is correct, including often overlooked details such as prior authorization. Patients have the time they need to fully understand what is and isn’t covered, enabling them to explore options on how to meet their financial obligation.

How often have Patient Access representatives gotten a call from a frustrated patient lamenting, “Why didn’t you tell me about this earlier? I can’t pay all of that right now!”

Along with working ahead, a progressive financial clearance model includes educating and helping patients plan for their financial responsibility, offering patient education and alternative payment options if paying in full presents a hardship.

Reduce denials in health care

Another benefit associated with improved financial clearance is a reduction in denials, many preventable through a front-end revenue cycle management process or measurement change. For instance, at nThrive we’ve helped health organizations realize a revenue uplift resulting from a decrease in medical necessity denials, which occur when Patient Access fails to verify that a procedure is justified.

Having good checks and balances in place for medical necessity and other upfront requirements also helps physicians, who experience frustration and financial loss when patients are denied coverage after services have been provided.

Real-world clearance results

The impact medical service organizations achieve when they shift their financial clearance function to an expert resource can be dramatic. For instance, nThrive helped a large health care system in Louisiana financially clear patients more than seven days out from their service date. This same health care organization has seen an uptick in cash collections because patients are financially prepared to make payments. And, medical billing denials are down from 4 percent to 1.5 percent, helping to increase cash flow. These are real results that any organization can achieve by leveraging technology, billing and collection process improvements and expert resources to streamline the financial clearance operation.

Is your health care organization struggling to financially clear patients? Are you challenged with growing bad debt from patient liability and claims denials? Read our checklist, “Five Ways to Offset Patient Liability” for more on how you can turn your Patient Access operation into a revenue generator and improve patient satisfaction at the same time.

You’ll also want to read our executive brief, “How financial services impact patient experience,” for a discussion on how trends such as high deductible health plans are changing the role of today’s Patient Access department.