It’s true. With the growth of high-deductible health plans, consumers are fast becoming the first and/or primary payer of physician and hospital bills, creating a big shift in the way providers capture revenue. Payment processes and workflows honed around collecting from health plans are shifting to a consumerism model of collecting from patients. So what’s a doctor to do?
Steps to success
Step one is to recognize the shift to consumerism, and most hospitals and physicians do. According to research Availity published recently, more than 85 percent of providers stated that patient financial responsibilities are increasing, and 90 percent noted the increase in high-deductible plans among their patients. Another 55 percent said self-pay among consumers is on the rise.
Step two is collecting from patients at or before the point of service. Yes, this can be a major workflow and culture change for many organizations and patients, but it’s critical to protecting revenue and maintaining a predictable cash flow. In fact, Availity’s research showed 90 percent of providers agree that collecting from patients before they leave the office is vital to financial health, and 85 percent say it’s difficult to collect from patients once they leave the building.
Walking the talk
Now here’s the rub: while the majority see the shift happening and acknowledge the importance of collecting from patients at the point of service, very few organizations are doing this effectively. Physician practices report collecting from 59 percent of patients at the point of service, but that only represents 35 percent of patient-owed fees. Why? It’s likely that the fees being collected are co-pays, but not the full amount due. For hospitals it’s even lower. They’re collecting from just 35 percent of patients up front, representing 19 percent of patient-owed fees. Too often, co-insurance and deductibles just don’t show up until after the claim is processed.
Is it panic time? No – but it is time to take action, and many providers are doing just that. About 81 percent of providers surveyed reported making recent investments in tools and staff to address the need to transform their collection processes, shifting them to the patient and to the point of service. One of the most recognized tools accomplish this transformation? Patient access
Transformation through patient access
For some, patient access may be very familiar – you may even be a patient access administrator in your organization. Hospitals in particular operate patient access departments. For others, the term may be a bit new. Simply defined, the patient access function ensures your patients have access to the care they need. Patient access solutions include a host of features to make that happen quickly and efficiently. They include capabilities like: eligibility and benefits, patient registration, payment processing and treatment authorizations.
As consumerism drives the need to transform provider collection processes, patient access solutions are well-suited to safeguard cash flows and revenues. In addition to the traditional features noted above, savvy solution providers are expanding their capabilities to include collection-focused tools, such as patient payment estimators, patient capacity-to-pay features, and sample scripts to help guide collection conversations with patients. The tools exist – they just need to be put into practice.
Consumerism is here and it is affecting the physician revenue cycle, but there are proven solutions you can implement to help you transform your collections and improve your organization’s financial performance.
Availity’s research revealed that most providers are in the early stages of defining the most efficient and effective point-of-service collection workflows for their organizations. To continue the forward momentum, providers should engage internal and/or external subject matter experts to:
Identify and implement the best tools and workflows to transform collection processes;
Train staff to encourage rapid adoption and utilization of those tools; and
Accelerate return on investment through increased cash flow and reduced bad debt.