Time-consuming and cost-intensive processes within outdated patient access and financial clearance operations contribute to delays in the patient journey from the initial point of contact to the date of service – delays that introduce inefficiencies into the process and contribute to lost revenues. Streamlining these patient access processes is crucial to ensuring that patients are financially secure and have timely access to necessary medical services.
A synchronized financial clearance methodology centered around a well-designed and efficiently operated patient access team and modernized processes will accelerate revenue by decreasing payment delays caused by front-end errors, reducing rescheduled appointments, and improving patient satisfaction. Driving this patient access overhaul are new technologies and innovative solutions that streamline operations by engaging people, processes, and technology through collaboration and communication.
It is an approach that also aids in greater revenue capture by proactively identifying and resolving patient eligibility and coverage issues before they become denials.
Best Practices for Optimizing Operations
By combining services and technology with several best practices, healthcare organizations can effectively enhance patient access processes and improve revenue.
The first step is to define a clear patient access strategy, which ensures all processes are aligned with the organization’s goals and objectives. The strategy should establish key performance indicators (KPIs) and metrics to measure the success of the operation, and outline the roles and responsibilities of each team member involved in the process to drive accountability and ownership.
Additionally, invest in the technologies that play an important role in optimizing patient access operations. For example, electronic health record (EHR) systems, patient portals, and other digital tools can streamline processes and improve patient satisfaction. Further, automating routine tasks such as online appointment scheduling and insurance verification can reduce wait times, improve efficiency, and reduce errors – all of which contributes to an improved overall patient experience.
Other best practices to optimize patient access operations include:
- Standardizing patient access procedures across the organization to ensure consistency, increase productivity, and minimize mistakes that result in re-work. Standardized workflows should outline each step of the process and the expectations for each team member involved. Future process changes or optimizations are more easily adopted when the processes and underlying training are already standardized.
- Proper training and education on the use of technology and other tools used in the process are essential for the success of patient access operations. Staff should receive ongoing education on changes in regulations and compliance requirements as well as policies related to insurance coverage.
- Establish metrics to track patient access performance, such as appointment wait time, insurance verification rate, prior authorization turnaround time, and patient satisfaction. Measuring and monitoring performance against goals is critical to identifying areas for improvement and optimizing the patient access process. KPIs should be defined, and metrics tracked regularly against benchmarks to identify trends and patterns. Performance should be reviewed regularly to ensure that the operation is meeting its goals.
- Foster a patient-centric culture to improving patient satisfaction and loyalty. Staff should be trained to focus on the patient’s needs and provide a positive experience throughout the process. Patient feedback should be solicited regularly to identify areas for improvement and address any issues promptly.
An effective patient access operation requires a clear strategy, investment in technology, standardization of processes, proper training and education for staff, measurement and monitoring of performance, and establishment of a patient-centric culture. By following these best practices, healthcare organizations can optimize their patient access operations, increase revenue, reduce costs and denials, and improve the overall patient experience.
US Radiology Specialists
The use of an “intelligent authorization tool” by US Radiology Specialists, which operates more than 180 outpatient imaging centers in 14 states, is an excellent example of the impact these best practices can have on patient access operations. By automating and optimizing prior authorizations, US Radiology realized significant operational efficiencies, reduced denials, and improved overall patient satisfaction.
Specifically, by automating prior authorizations, daily staff production doubled from an average of 60 to 120 cases per associate while the percentage of exams requiring manual intervention fell to just 5-10% of all scheduled exams. The US Radiology team is also able to work authorizations further in advance from the date of service, improving from an average of 3 days out to 9 days out.
As a result, US Radiology can provide patients with more timely access to care and allow staff to schedule appointments in advance to fill unexpected gaps in schedules – all without requiring an increase in full time staff.
Optimized Patient Access
Leveraging a powerful combination of automation tools and proven best practices enhances efficiencies, streamlines workflows, and creates the foundation for optimized patient access operations. The result is a synchronized financial clearance methodology that eliminates many of the front-end errors that create delays and drag down revenues.
Matt Bridge
Matt Bridge is Senior Vice President – Patient Access and AR Service Lines for AGS Health.
