Price Transparency and Consumerism have a direct impact on today’s hospital Patient Access operation, with more changes coming due to stringent federal and state regulations. Considered the hospital’s “front door,” the role of Patient Access has traditionally begun with the initial patient encounter, where staff confirm patient identity, verify insurance status and more.
Healthcare reform has changed the role of Patient Access substantially, focusing more on the expanding role and expertise of its staff. Today’s Patient Access expert is tasked with capturing patient information, plus educating and supporting a range of individuals – patients, other hospital personnel and providers – helping to ensure comprehensive, quality healthcare service delivery and improving patient satisfaction.
Healthcare industry challenges, such as a payor mix shift and rising patient bad debt, have also expanded the role of Patient Access into upfront collections at healthcare organizations across the country. A robust health information technology suite and Patient Access presence assist in securing patient out-of-pocket costs and/or alternative payment solutions, integral to maintaining a healthy bottom line. From the first patient interaction, today’s Patient Access team:
- Schedules healthcare service appointments
- Determines patient insurance eligibility
- Enters required demographic and billing data
- Collects co-pays, discusses alternative payment solutions
“The bar is set high regarding responsibilities required of a Patient Access team,” observes Susan Gurzynski-Wells, RHIA, senior product manager at HealthStream. “They must operate at maximum performance levels, create a positive patient experience and protect revenue integrity by ensuring appropriate insurance reimbursement and patient payments for services rendered.”
How can hospitals and healthcare organizations ensure that Patient Access is executing at a high level? Implementing key performance indicators (KPIs), providing education and mentoring your Patient Access representatives comprise an impactful first step to achieve patient satisfaction and revenue cycle success.
Develop and monitor Key Performance Indicators (KPIs)
To ensure a high level of productivity and accuracy, today’s Patient Access operation should be measured on Key Performance Indicators (KPIs) to monitor quality, process, financial and customer service. Healthcare organizations throughout the medical industry have established guidelines on appropriate Patient Access KPIs with examples, including:
- Quality – Best practice benchmark for duplicate medical record = 2 percent or less says American Health Information Management Association (AHIMA). Duplicate medical records can lead to patient safety issues. Patient Access has the best opportunity to validate patient identification and prevent duplication by reviewing key identifiers.
- Process – Benchmark for resolving prior authorization and medically necessary services – both key for successful denial prevention = >90 percent says the National Association of Healthcare Access Management (NAHAM). As part of patient scheduling/intake, the Patient Access team must validate that authorizations are in place and services are medically necessary.
- Financials – Benchmark for point-of-service cash as percentage of total cash collected >2 percent says the Healthcare Financial Management Association (HFMA). Patient Access staff must be familiar with the various types of up-front cash collection required.
- Patient Satisfaction – Benchmark for patient wait time is <10 minutes says HFMA. An impactful first encounter is key to preserving loyalty and ensuring that patients return for future services. A patient’s experience, including registration and wait times impacts their decision to become a loyal consumer.
Accompanying KPIs with specific department goals leads to positive outcomes, making certain that you set your team up for success.
Patient Access – A crucial role
In many healthcare organizations, the Patient Access team is the unsung hero, yet it often receives the least amount of training. Lack of Patient Access training can be a disrupter to revenue cycle success and patient satisfaction. According to recent studies, upwards of 50 percent of claim denials are due to errors occurring in front-end revenue cycle processes, such as registration and eligibility. Just a single misstep in any of the necessary functions can result in many downstream consequences, including poor patient care, fraud charges resulting from inappropriate billing, lost revenue due to denials or inadequate copay collection and potential loss of the healthcare organization’s license.
What can a comprehensive education program offer hospitals?
According to Darcelle Johnson, senior manager of Education Content Development at nThrive Education, providing colleagues with healthcare education that expands their skill sets and future opportunities can also help hospitals and healthcare organizations overcome the challenge of employee retainment. She recommends that providers:
- Invest in an online education system to keep colleague knowledge current and maintain standards of proficiency.
- Perform team assessments to identify knowledge and skill gaps that could affect the revenue cycle (Mission Health provided a colleague assessment for Patient Access that covered hospital finance basics, insurance and coverage, collections, patient communications, deductibles and coinsurance scenarios).
- Fill knowledge deficiencies and increase colleague skill levels through course assignments based on assessment results.
- Provide colleagues with opportunities for growth within your organization by offering certification and badge programs that broaden and enhance skill levels.
- Offer webinars that help colleagues maintain credentials and stay current with regulatory updates.
What does success look like?
A private healthcare consulting firm in Virginia provides staffing for their largest client across multiple locations. To prepare staff members, this consulting firm provides a comprehensive Patient Access training program. Along with organizational specific training, they assign nThrive Education online courses via HealthStream to supplement their training and reduce content creation costs at the local level.
HealthStream Patient Access courses from nThrive Education provide:
- Broader array of Patient Access/revenue cycle education – Prepares learners beyond what is possible during initial in-person orientation training
- Extensive orientation for Patient Access roles – Newly hired staff are better prepared for meeting client needs
- Efficient use of training time – In-house training reduced from four to three days, decreasing amount of necessary resources
- Individual training path reports – Adaptive learning targets areas where new employees need more focus
- Consistency in staff onboarding – Assigning the same suite of courses helps create a workforce whose preparation, knowledge and performance is more uniform, and aligns with the client’s expectations
The firm has received positive trainee feedback regarding the HealthStream Patient Access courses from nThrive Education. Confidence is high placing individuals in these roles, knowing they are well-trained and evaluated.
According to the firm’s spokesperson, “Training is a big piece of onboarding and proficiency, and it’s very specific in the extent to which it matches client needs.” She emphasizes the importance of learning that complements the firm’s commitment, adding that “the client expects a certain level of expertise in the work our people are doing. If we’re placing people in the organization who don’t have that level, it’s very clear from the start.” In addition to helping new employees bridge the gap between experience and knowledge, HealthStream and nThrive Education training helps the organization “use trainee test scores and the time they require to complete certain modules to determine the subjects where more focused time should be spent to best serve the client’s needs.”
It takes a village
Successful Patient Access in the hospital or healthcare system depends on the work and commitment of many; it’s about patient interaction, education, transparency, accuracy and providing clean information that feeds the revenue cycle downstream. It’s an area of the revenue cycle that is drawing more attention in the healthcare industry and will continue to do so as reforms continue to strengthen the clarity between hospital, patients and payors.
Learn more about how nThrive Education can improve revenue cycle management performance and outcomes at your hospital or healthcare system through optimized Patient Access solutions and healthcare education programs. Contact nThrive.