Becker's ASC Review

39 CODING & BILLING Creating the ultimate patient experience while strengthening your revenue cycle: technology, consumer protections, and best practices By Kylie Kaczor, National Medical Billing Services T he patient collection process has moved beyond simply col- lecting patient co-payments and sending billing statements. In today's healthcare environment, providers and their office staff are faced with the daunting challenge of reframing business practice to help maximize reimbursement from not only health insurers but from patients as well. A TransUnion Healthcare analysis uncovered that patient responsibility or patient out-of-pocket expenses rose on average 11% in 2017; a trend that does not appear to be slow- ing. With this heightened focus on patient collections, let us explore ways to positively impact the patient experience through the use of new technology, discuss consumer protections and the barriers they add to collections, and review other best practices that will help you maximize your revenue. Technology Both consumers and healthcare providers are battling the sustained presence of high-deductible health plans. Consumers are faced with the higher out-of-pocket expenses while providers are tasked with collecting higher copays. In 2017, patient responsibility made up nearly 30% of income for practices indicating that the patient is now one of the major payors in the healthcare space. With this type of marketplace presence, it is important for provid- ers to understand that the revenue cycle has a direct impact on the patient's overall experience. A positive or negative experience related to the cost of care received and subsequent medical billing has an impact on the patient's perception of care received. Why is that? e billing process is oen the first interaction the patient has with the facility and is oen the last. According to research from Fierce Healthcare, patient satisfaction ratings fall by an average of more than 30 percent from post-discharge through the billing process. In the event there are significant issues with the post-care billing, one would expect the satisfaction rating to fall even further, therefore col- lecting patient responsibility at time of service will allow patients to focus solely on their recovery aer care without continued financial burden. Additionally, in 2017, TransUnion reported that 68% of con- sumers were unable to pay their financial responsibility aer services were provided and they expect the percentage of patients not paying their medical bills in full to rise to 95% by the year 2020. Because of this, collecting patient responsibility at time of service is essential to increase your cash flow and decrease the administrative burden as- sociated with back-end collection costs. Already this year, we've watched the almost continuous barrage of headlines regarding healthcare technology; the expansion of tele- health, wearable health tracking devices, and cloud-based services amongst others. Technology is incorporated in all areas of healthcare and revenue cycle is no exception. Consumers want convenient ac- cess to healthcare and a streamlined process. As a result, providers are looking for ways to implement new technologies that promise to promote accuracy and efficiency while positively impacting the patient experience. To help providers collect these higher patient responsibilities, many practices are implementing automated tools that can evaluate patient benefits and eligibility and produce accurate time of service quotes. Having this information will better prepare front office staff and set proper expectations for the consumer. is type of technology implementation helps to streamline the time of service collections process while ensuring that patients arrive prepared with a full understanding of their responsibilities. ese estimates also offer the providers and office staff the supportive and accurate information they need to discuss personal and customized financial responsibil- ity with their patients, fostering a positive relationship between the provider and the consumer. Automation of this type can also help to reduce patient phone calls, improve patient satisfaction, and decrease administrative burden associated with collections. Oen, these tech- nologies are integrated with the practice management system or EHR which eliminates inefficiencies and helps to reduce demographic and insurance capture error; a common cause for claim rejection or denial. When a claim is rejected due to error or denied due to documentation, it is the provider who suffers as this creates a delay in claim adjudication and subsequent payment for service. Consumer Protections While you are meeting the challenges of collecting patient financial responsibility it is also important to remain knowledgeable about associated state regulations. In the event you are unable to collect full patient responsibility at the time of service, be sure to review your state's statute of limitation on consumer debts to ensure that you are compliant with collection practices and timeframes. Individual state regulation dictates specific time frames during which you have the right to attempt to collect debt from a consumer. ese limitations vary significantly across all states and may also include qualifying cri- teria; therefore, it is important to understand what your back-office collection practices may include. e concept of balance billing or surprise billing has been making headlines over the past few years because of growing concern from healthcare consumers and government officials. As a result, states are continuing to focus on the implementation or expansion of balance billing or surprise billing legislation. ough the concept of balance billing and the legislation associated is not new, many states are ex- panding their efforts to include greater consumer protections. ese laws are the result of the ever-increasing presence of high-deductible Both consumers and healthcare providers are battling the sustained presence of high- deductible health plans.

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