INNOVA ALEXANDRIA, VA 

There are any number of significant issues driving change within the health care industry in general and patient access in particular. Top among them: the rising cost of quality health care and the reduced ability to cover those costs.

Front-End Role in Managing Major Issues

Patient access employees are acutely aware of the patients’ worries about what they will owe for their medical care and whether they can meet their financial obligations. Daily, front-end employees encounter patients who tend to wear these worries on their sleeve, as patient anxiety about the need for health care is matched by patient anxiety about their ability to pay for that care.

To effectively manage patient concerns, front-end employees need to timely identify patient-pay balances and help guide patients in planning for the payment for those balances. Dialogue about payment of patient –pay balance and other payment issues should begin on the front-end, at scheduling, and continue through to patients’ arrival for services.

Front-end employee also is increasingly aware of just how critical their job performance is to a provider organization’s bottom line. Patient access professional understand that it is essential they effectively gather complete and accurate demographic and insurance data, as an essential first step is the reimbursement cycle. This awareness is enhanced further as, more and more, patient finance issues and challenges are being aired and discussed with patient access, as many back-end billing and collections problems can be remedied by improved front-end performance.

The patient access role in managing major issues, however, goes far beyond the processes for the two above cited functions: allaying patient fears about payment and working with them to identify payments options, and gathering complete and accurate registration data for their colleagues in patient finance.

The patient access role in helping to manage to two major issues that plague the industry required focused attention to many other front-end responsibilities. The myriad patient access role and responsibilities also include:

  • To deliver superior customer service, to external and internal customers;
  • To verify insurance benefits and coverage levels, to determine insured patients’ financial obligations and ensure timely and accurate billing of third-party payers;
  • To timely identify uninsured or underinsured patients who may need financial assistance with their Medical bills;
  • To develop solid working knowledge of administrative and/or clinical pre-service requirements, such as insurer preauthorization or certification requirements, or patient preparation requirements for services; and
  • To work effectively with colleagues within and beyond patient access, to achieve individual, departmental and organization goals.

Time-of-Service Collections

A key benefit in improving the pre-service functions within patient access is that front-end employees can the identify patient-pay balances prior to service and can prepare patients to pay those balances at the time of service. Of equal importance is that effective pre-service registration allows patient access employees to identify uninsured or underinsured patients who may need financial counseling or other assistance, to help with managing their medical bills. Front-end employee can offer these a variety of options such as all uninsured patients receive a discount off of total charges.

A focus on time-of-service collections is essential, and not solely to increase cash flow. Timely identifying patient-pay balances and coordinating that task with identifying patients’ ability to pay is essential as the self-pay portion of providers revenue continues to grow. Having accurate tools such as Passport Eligibility, Medical Neccessity and E-Cashiering has given the patient access staff the increase confidence to talk to patient about payments and options with confidence thus increasing patient satisfaction. In previous year this increased out point of service cash collections by 1.3 million dollars over the previous year and reduced our bad debt by 2.1 million dollars over the previous year.

Bottom Line:  The Front End

In summary, the front end is the bottom line. In the year 2007 as the Patient access leader I will continue to make sure embrace and ensure employees understand the importance of a financial focus on the front end will best serve our organization, our patients, and our community. 

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