The rise of consumerism in healthcare touches nearly every facet of the industry, including back end aspects such as the revenue cycle.
Nearly 40 percent of Americans receiving health insurance through their employer are enrolled in high-deductible health plans, according to a Centers for Disease Control and Prevention National Center for Health Statistics report. Deductibles have skyrocketed over the past decade. More than half of all covered employees pay $1,000 or more annually for single coverage.
And while consumer-directed healthcare puts the onus on individuals to play a more active role in their care and how it’s paid for, the movement – ¬part of an overarching industry shift putting consumers in the driver’s seat – also has implications for providers.
Improving patient billing is a critical piece of the puzzle. In fact, 35 percent of provider revenue now comes from patient payments – largely attributed in part to the shift in financial responsibility from employers to employees. Providers are acutely aware of the need to provide high-quality care to achieve patient satisfaction and maximize reimbursement, but that patient-centric mentality too often ends at a facility’s doors. A medical bill is the last touch point between patients and providers, and a negative patient experience can have far-reaching implications on a provider organization’s bottom line.
Despite advancements in technology – including eligibility verification solutions and denial management software – that have had a significant positive impact on provider reimbursement, the patient billing component of the revenue cycle remains largely ineffective. Sixty percent of respondents in a Mad*Pow study reported their medical bills were confusing, and close to 50 percent of those polled expressed frustrations after interacting with provider billing departments. This negative experience contributes to unpaid balances and can negatively affect patient’s credit scores.
Using a patient-first approach, it’s imperative that provider organizations implement standards to optimize revenue cycle activities, as outlined below. Focusing on elevating and improving patient billing can lead to immediate gains as an optimal patient experience drives engagement, a key factor in achieving financial goals.
Use of data science
Advanced analytics and smart segmentation can predict a patient’s propensity to pay on time and in full, but it’s critical to find out what drives individuals to pay, and to personalize communications to them accordingly. Considering only a single source of data, such as a patient’s credit score, provides an incomplete picture. Data points from a variety of sources, including a patient’s billing history and frequency of engagement with previous provider communications, must be examined. Historical patient data should be used to determine how often patients receive information related to their bill, the most effective methods of communication for the highest level of engagement and a cadence for payment based on what’s learned about the individual. Informed data should be continuously optimized using machine learning.
Increased transparency
Medical billing is often an emotional process for patients. Simplifying invoices can help eliminate strife. Invoices must consolidate charges from multiple providers in addition to clearly detailing amounts owed for provided services. While bills must be more comprehensive than the Explanation of Benefits, they should be as straightforward as possible, making it easy to understand services and amounts covered by the patient’s insurer, what the patient is responsible for, why and when.
Modern communications
Consumers expect to be reached where they are, regardless of the nature of the exchange. Many studies have shown the efficacy of modern communications in healthcare, including the use of email, live chat and text messages to successfully engage patients on a number of fronts – from decreasing appointment no-shows, to increasing medication adherence.
Providers must further utilize digital communications, updating their billing platforms to streamline and enhance the patient experience, and enabling features facilitating real-time interactions, such as live chat functions to field inquiries and triage questions without lag time.
To set new standards in revenue cycle operations, we must think beyond the status quo, leveraging modern technologies and data science to deliver highly-customized patient experiences. Leading with a patient-centric approach to billing will result in measurable progress toward achieving long-term patient engagement and satisfaction, ultimately helping providers meet financial goals.
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