The key to maximizing reimbursement and striving for healthcare payment lifecycle excellence is perfecting the patient access onboarding game. Patients present for treatment with an often limited understanding of their insurance coverage and plans, and sometimes confusing ideas of the prior authorization process and their financial responsibilities.

It’s up to us to help patients navigate the process and educate them to make solid, informed choices about their care. By leveraging real-time data using advanced automation, we can effectively discover existing insurance coverage, verify the patient’s insurance and benefits, and collect their portion upfront while also meeting our obligations in terms of prior authorizations.

Leveraging Data to Maximize Reimbursement

As healthcare consumerism continues to grow, patients are becoming more and more part of the financial equation. Technology and automation are allowing us to present more accurate and timely information so patients can better understand their financial contribution. It’s more important than ever that the business staff responsible for onboarding patients be equipped with the most accurate data, and that patient portions are collected upfront before the patient arrives for care.

First Step – Insurance Coverage Discovery

When a patient first presents for treatment or calls to schedule an appointment, it’s customary to ask about their insurance coverage, but how often are patients confused and unclear about their plans, benefits, deductibles, or possible secondary coverage?

Today, advanced automation software not only allows you to verify insurance coverage and benefits in real-time but is also able to discover non-disclosed insurance coverage that the patient may not even be aware exists. This might include Medicare, Medicaid, commercial insurances, or secondary coverage.

Relatively new, the process includes the following steps once account information is uploaded:

  • All undisclosed coverage is deep mined from clearinghouses and insurance payers,

  • Using probabilistic analytics and machine learning, patient demographic information, insurance profiles, and coverage benefits are identified and verified, and

  • Once previously unidentified coverage is now communicated back to the revenue cycle management or EHR/EMR system.

Second Step – Insurance Verification and Benefits

Simultaneously, it’s important to secure accurate and valid insurance and demographic information about the patient. By utilizing an automated insurance verification and benefits software, your practice will be able to track and confirm precise patient coverage details in real-time while avoiding later denials due to ineligibility.

Utilizing a seamless integration or portal, front office and scheduling staff are able to access the needed information to determine eligibility and benefits in real-time, including:

  • the patient’s eligibility and dates of coverage,

  • the primary or secondary insurance relationship,

  • co-pay and/or co-insurance due,

  • annual deductible met and remaining, and

  • any out-of-pocket maximums.

With the Infinx Insurance Verification package, emergent or problematic verifications would be handled by specialists in cases such as non-automated payers, etc.

Third Step – Collecting Patient Portions Due

Once the insurance information is determined, it is critical for overall practice financial health that all estimated patient portions due are collected before the time of service, if possible. Today’s consumer is conditioned to pay before receiving goods or services. Still, it is often the practice or hospital that neglects to ask for payment until the patient arrives or even after insurance has been paid.

With automated patient pay estimates, you would have the following:

  • Real-time patient pay estimates

  • The ability to incorporate provider fee schedules to determine accurate patient estimates based on current information

  • Robust cost estimation logic that enables precise and immediate amounts due

With strong, well-defined financial policies in place, expert collections training for staff, and clear-cut automated estimates available, patient portions collected before the time of service no longer have to slowly wind their way to either payment (often several months post-visit) or collections. Additionally, giving patients automated payment options greatly increases payments – patient portals, apps, email notification, etc.

Fourth Step – Prior Authorizations

By automating your prior authorization process through an artificial intelligence (AI) driven software solution, most approvals can be obtained in real-time. Prior authorizations can now be initiated in near real-time, tracked, followed up, and resubmitted (if necessary) without human intervention in most cases.

What once took several hours to several weeks manually can now be accomplished in minutes (or seconds), and unusual outliers can be followed up by expert billing specialists.

Unbelievably, according to the latest 2020 CAQH Index, prior authorizations are only performed by automation in about 21% of healthcare facilities. This means a great number of practices and hospitals are spending unnecessary time and resources, not to mention patient frustration, managing a burdensome and redundant system leading to denials, and lost revenue.

Streamlining the entire front-end patient access process brings improvements to your bottom line, and your patients. Their experience improves when they know and understand both your financial policies and their obligations while having easy access to payment avenues.

Contact us to request a demo and improve your reimbursement—and don’t forget to explore our solutions for the various patient access processes.