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Lack of the right technology to automate time-consuming, error-prone processes can put patient access departments at a big disadvantage. On the other hand, there is a concern that some technology investments may be a waste of money, particularly when all expenditures are being put under the microscope.
"Collecting cash at the point of service is not the taboo topic it once was," says Ron Camejo, director of revenue cycle practice at Chadds Ford, PA-based IMA Consulting. "This is partly due to a growing realization of the importance of upfront collections to an organization's bottom line, and partly due to the emergence of technology 'accelerators' that are simplifying the once-onerous task."
After implementing stand-alone applications, some patient access department are seeing impressive results. However, Camejo says when these are implemented as "components of a well-considered revenue cycle vision, the overall results can be greater than the sum of individual parts."
John Woerly, RHIA, CHAM, a senior manager at Accenture in Indianapolis, says that these technologies should be considered by patient access leaders in order of importance:
insurance eligibility/benefit verification tools;
an online benefits engine, which ties employer/payer information to managed care contracting;
patient liability estimation tools;
point-of-service collection tools;
propensity to collect/credit scoring tools;
online outstationed Medicaid eligibility screening;
application production tools, online charity application screening, and application production tools.
"Potential technology disasters include non-integrated, stand-alone systems systems that have limited payer connectivity, poor vendor implementation planning, and [are] not fully monitoring outcomes," says Woerly. "You need to be looking at results on a daily basis and reporting and tracking results."
Woerly says planning, training, and monitoring are the ways to avoid these pitfalls. "Measure current outcomes with denials, upfront collections, the number of Medicaid referrals and approvals, and number of charity cases approved," he says. "Know the full cost of the system change, including the impact on staffing, and the per-transaction cost vs. an annual flat rate."
Don't depend on vendors
Kristi Heussy, revenue and billing system manager at Virginia Mason Medical Center in Seattle, says that when reviewing a potential technology investment, she answers these questions: Will it fit with our flow? Will it benefit our patients? Will it give a good return on investment?
Heussy says that one mistake is to place too much dependence on an outside vendor, instead of working as partners. "The key for partnering is making sure you and the vendor have the same vision for what constitutes a good outcome," she says. For example, if a vendor is tasked with completing a coverage application for a patient, for them a good outcome is getting that work done. For the medical center, though, the good outcome is getting the patient coverage so that he or she may get safe, effective treatment and discharge, as well as payment for services provided.
Before investing in any patient access technology, Heussy says that you must do some upfront work in your department, as follows:
Involve staff in improvement work, such as eliminating waste and improving flow.
Understand who your upstream and downstream customers are. "Interview all parties to determine who is a customer of the service to ensure every aspect of the work is covered and sequenced," says Heussy. "Do not depend on a vendor to solve a problem that is deeply embedded in the flow of information in the hospital."
When talking with other users, ask detailed questions about the format of electronic information being returned.
Take the time to do site visits of the vendor's other customers. "It's helpful to see how other customers are using the product successfully," says Heussy.
A. James Bender, MD, Virginia Mason's medical director of health information, says, "Access, and the systems that support it, need to be focused on the patient's needs, and efficiently gathering the clinical, social, referral, and financial information that is needed for timely care and defect-free billing. The goals are seamless integration, first call resolve, and high reliability."
The information gathered at the time of a request for service is a "set up" for closure of the encounter. "The ideal system prompts the capture of information as data in a 'reusable' format as we build the patient's story. We avoid the waste and errors of duplication and then present this information where it is needed throughout the episode of care," says Bender. "In our vision, care begins at the request for service and ends when the medical interaction is complete and the bill is paid."
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