Patient Access: The Foundation of Revenue Cycle Enhancement Process

1.What is Patient Access

Patient Access typically involves scheduling, registration, financial clearance, and patient collection. In the middle, it comprises of Health Information Management and charge integrity, includes charge capture, clinical documentation integrity, medical coding, case management, utilization review for treatments and other functions. At the back is the billing mechanism, which looks after claims processing, contract management, denial management, payment posting and accounts receivable (A/R) follow-up, as well as reporting and benchmarking.

Patient Access at two levels:

Patient Access as a revenue cycle function begins with the initial patient encounter and includes:

1. Visit Scheduling
2. Confirming Patient Identity
3. Verify insurance coverage
4. Create an estimate based on treatment taken

Authorizations or referrals

1. Authorizations or referrals
2. Determine patient’s out-of-pocket financial obligation
3. Explore financial options based on the patient’s circumstance

2. What patient access means to different entities

For some, “patient access” refers to the clinic department that’s responsible for registration, insurance verification, cash collections, and so forth.

The health system strategists define patient access quite differently. To them, “patient access” includes everything that affects a patient’s ability to get the right care at the right time, in the right place. Hence we can say that, in some ways, “patient access” is practically a synonym for health care delivery strategy.

Today, in layman language, “patient access” indicates affordability, availability, and convenience

3. Scope of Patient Access Functions

The Patient Access as a core function of the Revenue Cycle starts with registration, scheduling and all of its support processes to patients, providers, and payers throughout the patient’s healthcare experience. Its main function is to supply information which results in building the foundation for medical records, billing & collections.

1. Registration: Registration is the first interface that the patient has with the health facility. In addition to validating demographic and insurance information other mandated fields are captured during patient registration. This information serves as the foundation of the patient’s medical record. The data collected is utilized by multiple members across the healthcare team, to include Patient Accounts, Patient Information, Clinicians and Health Information Management.
2. Collection of Insurance Information: The patient access department provides the input of the patients’ insurance or payment information. They scan and store multiple insurance card images and maintain a complete history of patient’s past, present and future insurances. The patient’s financial responsibility is determined by gathering data about insurance coverage, additional insurance, and their maximum allowable visits.
3. Point of Service Collections: Here the patient access personnel collect co-pays and deductibles at the time of service. Services that require co-pay, and the predetermined amount payable for each service, is specified to the patients. Many patients appreciate knowing in advance of service what their portion of the bill will be. This gives them time to prepare or to make arrangements for the payment.

4. Solutions that can be integrated

1. Automated Scheduler: Healthcare professionals find it difficult to cope up with fast-paced schedules and intense workloads. A key role in improving health outcomes is the value of utilizing an appointment reminder service to reduce no-shows and late arrival appointments. Sending these automated appointment reminders for a patient’s overdue or upcoming follow-up appointments, ensures your patient’s health is on top of your mind. Assisting the patients to stay updated with the help of reminders prevents illnesses and maintains the patient’s wellness.
   iPatientCare patient reminder system has already reduced no-shows, missed appointments and cancellations by providing tools that meet these needs through an integrated communication system. This is integrated with appointment scheduler and cloud EHR, so there is no need to upload patient demographics and appointments on a daily basis.
2. Manage Prior Authorizations from your EHR: Electronic prior authorization automates the PA process by allowing providers to initiate requests at the point of electronic prescribing (E-Prescribing). This direct integration uses the medication and patient’s insurance information to automatically select the correct request and populate it with patient information from records.
   CoverMyMeds’ integrated solution is available right now within iPatientCare’s EHR software at no additional cost. It’s an integrated electronic prior authorization (ePA) solution directly within the iPatientCare dashboard for any medication and all health plans, including Medicare Part D, Medicaid, and specialty medications.
3. Integrating Practice Management Software: With EHR technology becoming more popular, a lot of vendors have started integrating Practice Management Software to expedite medical billing in their practices. From the front office verifying insurances or collecting co-pays, to documentation of the visit with appropriate charge capture, submitting claims, posting payments, managing the collections and accounts receivable – all are linked together like a chain under its workflow.
   iPatientCare has a well-managed billing team that focuses on increasing practice revenue so that the physicians can give undivided attention to their patients’ health.

4. Medical Billing System: Administrative and financial processes are considered as the crucial jobs that demand perfection to maintain the required stability in the health care facility. It is a known fact that these processes are quite a time consuming as well as complicated procedures. However, there are multiple billing software that provides the facility to maintain admin and finance records. The most ideal thing that can be done with healthcare practice management software to make it better and productive is to integrate the same with your existing EHR. The health care facility can avail multiple benefits by integrating PMS with EHR.

WhitePaper: Growing Patient Responsibility and Decreasing Patient Collection

5. Patient Self Check-in Kiosk: Patient kiosk is tabloid and a phone-based software application that assists patients to do self check-in and also edit their basic demographic details. Patient kiosks can be considered as the new step taken to streamline and simplify the patient registration procedure. This Patient Self Check-in Kiosk frees the front desk from manual data entry tasks and allows them to utilize their time productively.
iPatientcare Self Check-in Kiosk makes the checking-in process easy and fun. Just direct patients to self check-in, the way we check-in at the airports. It is easy, efficient and engaging! Moreover, the patients can perform self check-in even before they arrive, using their smart-phones as an extension of the Kiosk! The patients love shorter waiting times and the touch screens for easily checking in.

6. Integrate Patient Access within the revenue cycle for optimal performance

Today’s top-most health care organizations are integrating their Patient Access operations to maximize resources, provide better patient care and gain more revenue from their services. Adopting a holistic approach involves implementing a broad range of integrated solutions, which include:

1. Engaging experts to optimize performance
2. Deploying technology for greater accuracy and efficiency; integration of EHR and PMS for clean transmission of the data.
3. Extending the revenue cycle to ambulatory, better-facilitating care coordination and answering to patient requests

7. Barrier to Patient Access

Some barriers to access to care include financial roadblocks such as

1. Lack of insurance coverage
2. High-deductible health plans
3. Limited financial means

While others are social or non-financial, such as

1. Provider availability
2. Access to childcare

8. What happens when patient access goes wrong

With Patient Access at the beginning of the cycle, all other functions depend on accurate and complete information from patient identification to entering insurance details to identifying financial needs. Things like coding complexity, miscommunication, and medical billing errors complicate the functioning of the revenue cycle. Here is a summary of various revenue cycle steps that generally occur during patient access operations and the basic challenges that often present themselves along the reimbursement way.

1. The first step of revenue cycle management is scheduling a patient for an appointment and registering him or her within a database. A detailed patient record helps educate a physician about various health issues and concerns early on. But bad quality data can lead to future revenue cycle complications.
2. In some cases, something as simple as a missing signature in a patient’s chart can lead to claims denial.
3. Eligibility snags are allegedly one of the most common reasons a claim is rejected
4. Mismanagement of patient access functions can lower patient and clinical satisfaction scores and damage the reputation of the organization

9. How to improve patient access

Generally, to strengthen the patient access, embracing technology within the revenue cycle is key. The new age of Patient Access requires better alignment to deal with key issues facing organizations and the community. The goal should be to holistically integrate Patient Access within the revenue cycle for optimal performance, focusing efforts around people, process and technology to better address client needs. Achieving the highest results requires strategies and expertise that can address the patient as an individual consumer, keeping them at the center of the process.

Greater synchronization of the different aspects of the revenue cycle will only increase the likelihood of reimbursement delivery, improve patient communication, and make sure high-quality care delivery is the ultimate result.

10. Consider outsourcing if you don’t have the internal expertise

Patient Access has become the first line of defense for every health system’s ability to pro-actively provide access and achieve a better bottom line. It has been estimated that the Patient Access functions are responsible for 80 cents of every dollar coming into a hospital facility.

Consider outsourcing to a single vendor that takes a holistic approach to the revenue cycle — incorporating solutions that spread across the entire process from patient access to payment resolution. This way, you’ll be able to eliminate the administrative workload associated with dealing with multiple vendors and will be assured that every component is optimized and plays well with the next while minimizing silos.

11. Why iPatientCare

iPatientCare is a leading healthcare technology company providing Cloud-based Unified System integrating EHR, PMS and RCM technology enhancing patient care through care management/coordination/analytics, and reducing costs of care delivery At iPatientCare, we help clients address today’s evolving Patient Access needs. As a single source, we can create standardization and accountability across all of your revenue cycle operations.

Learn more on how iPatientCare can help you meet your challenges – from reducing bad debt to increase collections, improving efficiency and revitalize your Patient Access operations. Fill free to contact us.