Success at the front end of your rev cycle depends on efficient patient financial clearance and a supportive patient financial experience. But beyond illustrating a clear picture of fiscal responsibility for patients and potential reimbursement for providers, the accuracy of data collected at the front end is vital to swiftly, successfully processing claims.
But the demands at the front end can often prove a tough challenge for healthcare providers of any size. Consider a recent study that found denied claims are most often associated with breakdowns at the front end, with 12.4% denials caused by problems during authorization or precertification, 14.6% by invalid claim data and 23.9% attributed to registration and eligibility errors.
Why errors build up on the front end
A recent report found most healthcare organizations have only automated 25% of their financial processes, so it’s not surprising you can track numerous long-standing rev cycle issues to the front end. Without automation, providers must rely on manual processes and contend with tasks that drain an unnecessary amount of staff time and resources.
And when staff strained, processes like financial clearance are even more prone to human error, which usually leads to denied claims and dissatisfied patients. In the end, it all adds up to a set of time-consuming, manually intensive tasks prone to errors that can greatly reduce potential reimbursement.
If you’re a provider who finds themselves struggling with these issues, read on for a look at some critical front-end areas where an automated solution can prove to be an invaluable tool.
Key front-end areas you can automate:
Registration quality assurance
It’s vital to correctly record a patient’s name, demographic details, insurance information, medical history and payment info (if possible). All of this seems simple, but anyone who has worked in healthcare long enough will tell you human error and inefficient processes are bound to create inaccuracies or leave out critical insurance information.
But with an automated solution, staff can take advantage of tools that quickly review relevant patient details and flag errors in real time, helping to greatly cut down on mistakes and making registration a more accurate, efficient process overall.
A proper registration solution elevates the quality assurance process, which means staff wastes less time inefficiently reviewing patient information details by hand and more time getting patients comfortable and informed about their fiscal responsibility. It can also provide exception-based workflows and worklists to handle menial operations, letting staff concentrate on identifying root cause issues and address high-priority tasks that require their attention.
Eligibility verification + authorization
Eligibility verification and authorization are another critical area where automation can play a key role. In fact, the 2020 CAQH Index found that medical plans and providers as a whole have already avoided spending $86B thanks to those who have already moved from manual to electronic eligibility and benefit verification.
An effective solution will quickly verify if a patient has coverage and whether their registration details have been properly entered. That includes details on contact info, personal background, additional demographic info, patient history, the number of visits that will be covered and, perhaps most importantly, what sort of costs the patient will be responsible for, all seamlessly checked behind the scenes.
Predictive analytics powering these solutions also improve the accuracy and speed of the eligibility verification and prior authorization processes. A provider can now use AI and RPA tech to automatically initiate submissions and verify patient details, using a comprehensive archive of requirements, clinical documentation and insurance info to easily manage straightforward tasks or flag accounts with high denial risks.
The tech also benefits patients. More accurate information is made available more quickly, ensuring staff are swiftly equipped to help them understand their financial responsibility while simultaneously unlocking stronger insight into their propensity to pay.
Patient estimation + price transparency
Not only is it vital to have tech that can review and verify patient eligibility information, it’s also critical to have tools to help accurately estimate what a patient can reasonably be expected to pay before they even come in for their first appointment.
Patient estimation and price transparency tools help providers build a more positive, transparent experience that builds patient loyalty. With automated, real-time eligibility checks and high accuracy, up-front estimates, patients have a clear idea of their fiscal responsibility and are better equipped to deliver full reimbursement.
Meanwhile, price transparency tools make it easy for providers to give prospective patients simple, convenient and self-generated rundowns of the most common procedures and associated costs, based on accurate eligibility assessments. Together, these tools lay the groundwork for providers to not just set up clear financial expectations, but to also help plan and manage their finances, ensuring they’re better able to pay.
Wrapping it up: why automation is a critical font-end rev cycle tool
It’s often seems easier to approach problems in the rev cycle reactively, rather than proactively. But when it comes to the front end of the revenue cycle, a reactive approach is bound to create more issues than it solves, bogging down team members with an escalating to-do list of corrections and fixes while the patient experience suffers and your potential for denied claims escalates.
Waystar’s full end-to-end RCM platform is fully loaded with tools to simplify and unify your entire revenue cycle. If you’re looking for a way to truly elevate your front-end processes, check out how our platform can help you build smarter, stronger and simpler workflows and actionable financial insights. Click here to find out more.
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