Patient access marks the start of the patient journey and produces a lasting impact on the individual patient’s experience. An effective process ensures timely access to necessary medical services and efficient operation can have a significant impact on the financial performance of healthcare providers in securing appropriate payments for the patient access services they provide.
However, managing processes such as appointment scheduling, insurance verification, prior authorization, and collecting co-pays and deductibles is not without challenges. A poorly functioning patient access system can lead to lost revenue and the costs of rework, denials, and appeals can add up quickly and further erode margins. In fact, approximately 50% of denials point back to front-end revenue cycle management (RCM) issues.
Overcoming patient access services challenges
Common challenges healthcare providers face when seeking to provide a synchronized financial clearance approach as detailed in our recent webinar include:
-
Increasing Patient Volume: As the demand for healthcare services continues to increase, healthcare providers are under pressure to manage a high volume of patients. This can lead to long wait times for appointments and delays in obtaining pre-authorizations, potentially resulting in rescheduled appointments and missed opportunities to capture revenue.
-
Financial Clearance: Insurance verification and Prior Authorization are critical components of patient access operations. However, they can be time-consuming and complex processes. Healthcare providers must verify insurance coverage, determine co-pays, and obtain pre-authorizations prior to service.
-
Inadequate Technology: Patient access services require robust technological solutions to manage the high volume of patient's appointments. However, many healthcare providers still rely on manual processes or outdated technology, which can lead to errors, delays, and reduced margins.
-
Inadequate Staffing: Financial clearance operations require skilled staff to manage financial clearance processes and ensure timely payments, while many times also playing a significant role in the patient experience. However, many healthcare providers struggle to find and retain qualified staff.
-
Compliance Issues: Healthcare billing processes are subject to strict compliance regulations. Healthcare providers must comply with HIPAA regulations, coding standards, and other regulatory requirements such as the No Surprises Act (NSA). Failure to comply with these regulations can result in fines and penalties and high volumes of patient-initiated Independent Determination Reviews (IDR) hearings.
Effectively addressing these challenges ensures patients have timely access to services and that healthcare providers receive timely payments for patient financial services for care provided. An integrated approach is critical in today’s consumer-minded market to protect what is due to the healthcare organization. Listen to our webinar, "Revolutionizing Patient Access: A Synchronized Approach to Financial Clearance," to learn more about challenges faced by healthcare providers in providing patient access services and the impact on revenue. Then watch for our upcoming article that shares best practices for executing a synchronized financial clearance operation to mitigate these issues.
Matthew Bridge
