Why Revenue Cycle Management Needs Greater Patient Advocacy
"We try to locate providers as closely to where patients live as we can. Unfortunately, many of the closest providers are still more than 200 miles away.”
By - Does a holistic or more selective approach to revenue cycle management make or break a healthcare organization?
Lynn Giddens-Branscum, Revenue Cycle Director at Wise Health System, chatted with RevCycleIntelligence.com to offer her perspective on how providers and patients alike are left behind when revenue cycle snares ensue and where top industry focuses are as the end of 2015 comes to a close.
Patients without policy understanding are without power
One overlooked revenue cycle challenge is financial counseling where patients receive financial assistance to better understand patient portions, says Giddens-Branscum.
“Helping patients better understand the caveats within their policies so they'll have a realistic expectation of what their patient portions are going to be helps the revenue cycle."
Another overlooked revenue cycle area for is front-end customer service.
“We often have recurring patients. They may start with an ER visit, end up in the OR, and ultimately, on a patient floor. If we take care of that benefit understanding from the very beginning, they can make wiser choices for themselves as they go along,” she says.
“We are in the process of changing the point where that type of contact happens with the patient. Previously, that conversation wouldn’t happen until the patient had met with their physician and had a procedure scheduled.”
This contact only happens from a financial/counseling perspective for unfunded patients, she asserts. Patients with insurance who are trying to make decisions based on a clearer understanding of their benefits are often left in the dark.
Patient advocacy a challenge when providers are far away
One of Wise Health System's greater 2016 focuses involves the development of a patient advocacy position, states Giddens-Branscum.
When a patient initially registers, he or she will hopefully have an advocate to help answer future hospital service questions, statement inquiries, or general care concerns perhaps regarding a specialist or primary care provider, X-ray concern, or authorization process, she explains.
“That will give them a registrar that's familiar with their policy and with a patient's different scenario,” she states.
Although increased transparency is a key trend to focus on, Giddens-Branscum maintains there are still numerous challenges requiring more attention.
“Some payers only update the online services and providers every 30 days. Some don’t update them for 90 days at a time. So, providers can drop off those payers every 30 days, or more frequently depending on their individual contract. This kind of leaves the patient not knowing what they’re supposed to do.”
“As patients are researching to make sure they have insurance under Affordable Care Act requirements, many of our patients have purchased policies not realizing the area where they live doesn’t have providers for the area they purchased because the providers have all elected not to participate in that specific plan.”
Reaching out to payers serves as a viable solution
Patient education poses a solution to these problems, she says. However, even the most educated patient struggles when healthcare providers are nowhere to be found for hundreds of miles.
“We educate the patient. We try to locate providers as closely to where patients live as we can. Unfortunately, many of the closest providers are still more than 200 miles away.”
“In those instances, we reached out to the payers to see if they would do single-case agreements. Then we typically advise the patient the next time there's open enrollment, they pay attention to where provider networks are and make sure providers are in their area.”
Key strategies include advance planning and education
Giddens-Branscum recommends several strategies to help improve real-time data collection and point-of-service endeavors.
“Verify benefits as far in advance as you can so those patients know what you're going to expect the day that they come in for that planned procedure. Or educating and having a solid plan in the emergency room or urgent care center if that's the type of organization you operate.”
“Strategically have a plan for admissions to know what to be asking for, whether it's a funded or unfunded patient. Education at that point makes us more successful. And even if we don’t collect the money that day, being able to collect it prior to it going to bad debt.”
Looking ahead into the future, Giddens-Branscum says of key precedence are community-based solutions with a focus on population health. Considering a holistic approach to revenue cycle management is a key strategy for success, she asserts.
“We've got ACOs that are out there. The Affordable Care Act is still out there. We are really trying to recognize the challenges our patients face and measure and weigh those against challenges organizations face, related to bundled payments and just everything as a whole. I don’t think any individual piece of the revenue cycle makes or breaks an organization. It's the revenue cycle as a whole.”
