This Isn't Your Daddy's Chevy

Max Carter, for HealthLeaders Media, March 25, 2008

Still, the classic mandate from any CEO, CFO, or business office manager is, "I want each patient registration to be accurate and fast." And the classic response from registrars, although seldom stated out loud, "Pick one and call me back!"

Due to resource and time constraints, registration and admissions personnel cannot realistically meet the demands of today's revenue cycle using manual processes. Automation is required in order to close revenue cycle gaps.

Automated technology gives staff the ability to verify patient data at any and all points during scheduling, pre-registration, registration and admission. By confirming patient insurance eligibility, benefit types and levels, current address and co-pay and deductible amounts up front, providers are greatly increasing the likelihood that they will collect for each service performed.

But automation alone is not enough. To effectively and consistently close revenue cycle gaps, the ideal technology must have the ability to link patient inquiries. For example, if a patient presents in admissions as self-pay, then technology can automatically run his or her information against Medicaid to check for coverage, based on state of residence. If no coverage is found, then an address verification and credit score could be processed to determine the financial risks associated with treatment, particularly in non-emergent scenarios.

Automated technology can also aid front-end staff in a number of other critical functions, including:

• Pre-certifications for routine hospital stays or outpatient procedures. Pre-certification is usually done before admission for non-emergency care or shortly after admission for urgent or emergent care. It is increasingly required by some health plans for reimbursement.
• Validating procedures against medical necessity for accurate diagnosis codes. Validating medical necessity is the responsibility of the provider and should occur before services are rendered. If a Medicare procedure fails validation and the patient was not notified in writing in advance of providing the service, then the hospital cannot collect for that service. Medical necessity validation can be automated through technology to help hospitals avoid millions of dollars in potential losses.

The actions above should be triggered by technology, not done manually. Doing so:

• expedites the registration and admissions process, which improves patient satisfaction
• improves data accuracy by eliminating human error
• reduces claim rejections and denials, draws faster payment and minimizes re-billing in the back end
• improves registration staff efficiency
• dramatically boosts collections

Just as we've become accustomed to the bells and whistles of modern automobiles, healthcare providers should expect technology to make for a faster and more efficient revenue cycle.

Providers that implement the right technology will find that when their managers make the recurring mandate, "I want all registrations completed accurately and quickly," the staff response changes to "Not a problem--we have the tools to get the job done!"

Automation is the only sustainable approach that will effectively bridge revenue cycle gaps between the front and back ends.

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Max Carter is vice president of sales for Passport Health Communications, Nashville. He can be reached at max.carter@passporthealth.com.

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