The age-old hospital dilemma…how to provide quality care to members of the community while ensuring gold-standard collections and a healthy bottom-line?  While the answer is complex, multi-faceted, and brings together issues such as third-party contracting, governmental policy development and reimbursement best practices, one thing is for sure — patients are now responsible for a greater share of the costs associated with their care and capturing that amount is critical.

The patient portion due is not by any means inconsequential, and costs associated with collections are well known.  In fact, the CDC released a report in 2018, stating that 43.2% of people under 65 with private health insurance were enrolled in a high deductible health plan.  But what can be done to improve the accuracy, speed, and timeliness of patient collections?

Improving Patient Access with Artificial Intelligence (AI) and Automation

From the time a patient (or provider’s office) calls to schedule their test, procedure, or surgery, collecting timely and accurate information lays the foundation for early and efficient collections.  Working with your provider partners through integrated technology will ensure swift and highly accurate patient portions are determined and are actionable by admissions personnel.

Integrated Solutions that Leverage AI

Managing a patients’ financial obligations starts with collecting accurate demographic information and flows directly to the bottom line by impacting reimbursement from insurance as well as accurately determining the patient’s portion.  With an integrated and comprehensive solution, hospitals can more accurately manage the entire patient access process while also building solid and loyal relations with patients.

Enlisting a multi-faceted, cloud-based software that uses HL7-based bi-directional integration allows these functions to happen in real-time:

• Insurance Verification and Benefits Eligibility—Accurate and immediate verification of a patient’s eligibility is paramount in kicking off the entire reimbursement process.  With automated eligibility and remaining benefits verification, your admissions professionals can proceed with efficient scheduling meeting the patient’s needs quickly.

• Prior Authorization (PA) Approval—Intuitive and seamless processing of PAs in real-time with full transparency. Automation and AI-driven technology allows requests to be submitted to the appropriate payer, monitored and followed up intuitively, and alerts and notifications updated continuously.  By automating the PA process, significant time is saved by eliminating the manual, burdensome administrative workflow.

• Patient Portion Estimation—Once your admissions professionals have secured a valid PA and verified eligibility, an automated patient portion estimate now becomes available, and patients can be informed of their financial obligation.  At this point, your staff can proceed according to your well-defined financial policies, i.e., collection, payment plan, financing, etc.

By harnessing the power of automation and AI through patient access technology, your physician group, imaging center or healthcare facility can be better positioned to manage the portion of costs that fall to the patient.  This allows you to collect these amounts before the patient is seen (or the procedure/surgery is performed) and reduces the follow up required to collect amounts due several months down the road after insurance has paid.

Last, by comprehensively collecting and processing robust data that informs the entire payment lifecycle, you’re not only able to improve revenue, but also reduce the need for denials management and collections at the back end.  Additionally, a system-wide effort to integrate many of these solutions with providers and testing facilities within the hospital’s catchment area leads to further efficiencies and strong positions for future contracting.

Contact us to learn more about improving patient collections through AI and prior authorizations.