Skip to main content

Eligibility Software Saves Small Hospital Big Bucks

Analysis  |  By  
   January 03, 2017

Revenue cycle software lessens back office strain, increases provider and patient confidence, and reaps monthly savings.

A tiny change to how a small hospital uses technology is resulting in big savings of between $3,000 and $10,000 a month.

Iroquois Memorial Hospital, a 25-bed facility in the eastern Illinois town of Watseka faced a problem. Patients were experiencing high deductibles and copays than in the past, found registering at the hospital to be increasingly nerve-wracking, as they were not able to be ascertain their total out-of-pocket costs until after claims were processed.

Meanwhile, the hospital, which is located 80 miles south of Chicago, had a problem of its own. It faced bumpy claims adjudication and a burdensome post-visit hospital collection process.

"In the past it wasn't so important that money was collected up front," says Rebecca Wright, vice president of strategic planning. "We tried to change that, [and] to change the whole entire revenue cycle. Before, it was always done in the back [office] after the patient left. We are now trying to move things to the front."

Hospitals Say 'Show Me The Money' Before Treating Patients

In other words, revenue collection at check-in was insignificant.

But by implementing eligibility software, Patient Access from Availity, along with a healthy dose of patient and staff education, Iroquois was able to realize an average monthly savings of $3,000, Wright says.

The savings has spiked to $10,000 when the calculation includes a reduction in eligibility-related issues including claims rework previously required in the business office, as well as collections activity now avoided, she adds.

In the business office, the hospital's billing staff educated the registration staff, on what constitutes a clean claim, how important it is to have the correct information such as the correct insurance plan, and reviewing what it means "if a patient asks what a copay is, or a deductible, or co-insurance," Wright says. "We get a lot of that."

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

Get the latest on healthcare leadership in your inbox.