Waystar delivers cloud-based technology that simplifies and unifies the healthcare revenue cycle—and brings more transparency to the patient experience.
Denials in healthcare are an ever-present, and ever-increasing, problem.
In 2022, denials made up more than 11% of claims.1 And, if left unchecked, they can severely impact an organization’s financial health — and future.
Between outdated technology and manual workflows, following up on denied claims is a drain on staff, time, and money. In fact, unresolved denials can create an average loss of up to 5% of net patient revenue.2 On top of that, denials are a constantly moving target due to new payer rules, patients switching medical plans, and other factors outside your control.
So, how do you ensure your organization is proactively preventing and managing denials? Start with four steps.
1. Know the most common causes of denials
Denials occur for any number of reasons, but many stem from errors or omissions in the following: registration errors, medical necessity, timely filing, pre-authorizations, duplication, additional information requested from the payer, or coding.
Take action:
Allocate time and resources to properly analyze your denial data.
Once you have a clear understanding of the most common denials for your organization, prioritize areas for change.
Examine your highest impact workflows, and apply technology to key areas.
2. Optimize workflows to prevent denials
The best way to combat denials is to prevent them. Revenue cycle processes for eligibility verification, prior authorization, and claim follow-up have huge downstream impacts on denial rates.
Take action:
Examine your eligibility verification, prior authorization, and claim statusing workflows.
Study your top payers’ policies related to medical necessity.
Proactively integrate rules within your EHR to address those details.
3. Build an automated denials process
A timely, comprehensive process is key to managing denials, and today, that has to include automation.
Take action:
Use software to identify appropriate coverage.
Leverage predictive analytics to identify which denials are most likely to be successfully appealed.
Use purpose-built automation to prioritize which denials to work first, efficiently route work, and even automate the appeal creation and submission process.
4. Track, report, and determine the root cause of denials
To continuously improve both denial prevention and denial management, tracking and reporting is crucial. To do it well, you must systematically capture the reasons for denials.
Take action:
Pay attention to all denials. Most are remitted electronically, but don’t ignore the ones that come in via direct correspondence with payers.
Create a process that captures and reports the root causes of denials. Cataloging will enable you to monitor denials by type, frequency, value, and payer.
Establish a team or workgroup to address denials and report on trends.
If you stick with this process, it will reveal critical opportunities to make your revenue cycle run more smoothly.
The patient financial experience has never been more important. Learn why your organization needs a comprehensive, automated approach to empower staff and patients.
KEY TAKEAWAYS
50% of patients are frustrated by the healthcare payment process, and over 60% would consider switching providers for a better experience.
Providers can improve the patient financial experience by using a complete platform, offering clear communication, and leveraging purpose-built automation.
Positive patient experiences build loyalty. Loyal patients can contribute up to $1.4M in value over their lifetime to a health system.
Waystar's smart platform simplifies healthcare payments for providers and patients so they can focus on what matters most: caring for their patients and communities.
When it comes to the patient financial experience, healthcare is playing catch up. Consumers have long expected a consumer-first approach in other industries. Now they want the same from healthcare – and many feel they’re not getting it.
Studies show that half of patients are frustrated with their provider’s billing and collections processes. What’s more: 63% say they would consider switching providers for a better patient financial experience.
That puts providers in a tough spot. Not only do they need to provide a consumer-friendly experience in a complex industry not built for patients to bear this level of financial responsibility, but they must play catch up to other consumer health companies, alternative care options and big-box companies to keep patients happy.
The stakes for creating a frictionless patient financial experience have never been higher. Every organization needs to have a comprehensive approach that meets today’s high patient expectations.
In this article, we’ll walk through the critical elements to improving the patient financial experience and how providers are applying these strategies to achieve success.
Critical components to improving the patient financial experience
First, providers must put the right foundation in place for sharing information – not only with patients, but also between their team members. Providers need a complete, efficient platform that’s user-friendly for patients and for the staff patients interact with. Most providers don’t have that. Their technology is structured for departmental or functional efficiency rather than for the patient experience – something that depends on connected processes and ease of navigation. Having that foundation is critical to putting the right data in the right hands at the right time.
Secondly, once providers have the right platform, they need to empower their staff to provide clear communications pre-service and throughout the patient journey using these tools. When your staff has a system that prevents unnecessary delays related to insurance verification, or one that accurately estimates what patients will owe and why, they now have the power to create a better patient financial experience. Put yourself in a patient’s shoes – we are all patients, after all – and think about what you need as a consumer. You want convenience and flexibility; you want to engage how and when you choose; and you want the same kind of transparency and control you have everywhere else in your increasingly digital life. The right system will allow your staff to give all of this to your patients.
Third, providers must leverage automation where appropriate. Given the challenges most organizations are having in hiring and retaining their workforce, purpose-built automation is crucial. Not only does it free up staff to focus on meaningful patient interactions rather than tedious manual tasks like prior authorizations, but it also leverages technology to improve the accuracy and efficiency of these processes.
Not all automation is created equal: purpose-built automation is critical to a successful strategy
Automation won’t be as effective if it doesn’t fit within your workflow and learn as it goes to provide ongoing intelligence. Purpose-built automation, on the other hand, goes beyond alleviating staff burdens to drive and shape workflow.
For example, general automation can help your staff move data or complete high-volume, low-value tasks. Purpose-built automation, however, takes it one step further, helping your staff with high-value, nuanced efforts such as:
Confirming eligibility in real time to prevent downstream denials
Securing prior authorizations without chasing down the information or disrupting the patient’s access to care
Generating and delivering accurate patient estimates that empowers staff and patients curating the right kinds of messages based on patient preferences so they know what they owe, why they owe it and how best to pay
This type of automation can have a profound effect on the patient financial experience as a whole. When processes work faster and more accurately, patients are happier, and happier patients yield more payments. In fact, studies show that nearly 75% of satisfied patients pay in full, while only 25% of unsatisfied patients do.
The patient financial experience is impacted by foundational tasks that occur long before they receive a bill
The reality is that things like eligibility checks and authorizations are critical components to your patient engagement strategy. If they aren’t completed quickly and correctly, you run the risk of frustrating the patient, delaying care, or creating a negative patient financial experience.
Again, look at it from the patient's perspective. If your eligibility isn’t correct upfront, or if the appropriate authorization isn't secured, that can lead to delayed care, denied claims, or even patients being inappropriately billed directly. All of those contribute to a negative patient financial experience, which decreases loyalty – and loyalty matters.
Experts estimate that a patient can provide upwards of $1.4M in value over their lifetime to a health system. That means building loyalty is critical, not only to the patient experience, but also to an organization’s long-term financial health.
Increase loyalty with better processes throughout the full patient financial journey
The organizations that stand out to patients are the ones with better accuracy and effective upfront processes – both of which depend on how things work behind the scenes. In order to build loyalty, providers need great financial clearance and great engagement strategies.
While creating a better financial experience is complex, providers can start by ensuring:
Automation is purpose-built so it shapes workflow and learns as it goes.
Eligibility solutions gather and surface data in the most useful way for staff.
The patient engagement strategy considers patient preferences, propensity to pay, and patient-centric payment options.
Meet patient and staff expectations by refocusing teams on higher-impact activities, while leaving the tedious work to automation
Many providers are struggling to find staff. The hard truth is that most won’t be able to hire their way out of this crisis any time soon. So, the best way forward is to innovate – to find better ways to do things, not more people to do them.
Take pre-service estimates. With purpose-built automation, analytics and artificial intelligence, organizations can accurately determine how much a patient will owe in addition to the best time and method to deliver these estimates to patients. They can deliver them via the patient’s preferred communication method, which saves resources. And they can let staff know which patients have a high propensity to pay and engage so they are able to prioritize the most impactful patients and accounts. This drives more payments, saves massive amounts of staff time, and frees them up to focus on more complex tasks. Most importantly, it leads to a better patient financial experience by getting patients the information they need, how and when they need it.
Again, the critical difference here is that the automation is purpose-built, not off-the-shelf. Intelligence and personalization are key when you’re looking to reduce friction and build trust with patients while easing the demands on staff.
How providers successfully utilize these strategies to improve the patient financial experience
Over our multi-year partnership, UCHealth has used Waystar’s automation to improve their prior authorizations process. The result: They’ve increased their authorizations days-out working window from 2.5 days to 9 days. This ensures patient access well in advance of appointments, which reduces rescheduling or delayed care. And it ensures that the patient’s experience starts off right.
Another health system in Southern California has seen phenomenal results by pairing a thoughtful patient engagement strategy with Waystar solutions. By customizing payment options and prioritizing outreach based on propensity to pay, they only follow up on bills that are likely to be paid. The result: they increased payment collections by more than 50% and improved patient satisfaction scores without adding any staff to their small team.
A major health system in Texas is another great example of an organization where proactive patient engagement works in tandem with automation. “Waystar helps them automate the creation and delivery of pre-service estimates – with 70%+ of their estimates requiring no manual effort. Moreover, patients can access that information – right alongside all their other information – directly within their health system’s mobile app. The result: Because the information is delivered automatically, in their own app, patients get better estimates seamlessly, without staff doing extra work.
Learn more about how your organization can reduce manual effort while improving the patient financial experience.
Your organization doesn’t have to give up its processes or approach to leverage purpose-built automation. The right solution should fit in seamlessly with you, your staff, and your patients.
For more information on how to empower patients and providers with a transparent and accurate financial experience, view this recent on-demand webinar.
This year has been volatile for our nation’s hospitals.
COVID-19 has created once unthinkable challenges in managing clinical staffing, supplies, patient volume and financial uncertainty. The financial strain on hospitals to combat COVID-19 has forced them to take drastic measures, from furloughing staff to closing their doors to communities they’ve served for decades.
While the conditions causing this financial disruption may be present for months ahead, there are steps hospitals can take to increase revenue capture in 2021. Check out three of these strategies below.
#1 – Automate finding and collecting on uncompensated care
Uncompensated care was a major challenge for hospitals prior to the pandemic, with an estimated $41.3 billion in uncompensated care in 2018. With soaring numbers of unemployed and uninsured Americans due to the struggling economy, the Department of Health and Human Services (HHA) distributed $2 billion to hospitals based on their Medicare and Medicaid disproportionate share and uncompensated care payments. Hospitals will likely continue to face high levels of uncompensated care in 2021.
Hospitals can use automated coverage detection technology to find unknown patient insurance. This technology should provide actionable results that clearly articulate active and inactive coverage, even if the patient lacks an insurance card or coverage information. Additionally, this technology reduces collection costs by automating the search for active coverage. It also slashes AR days, maximizes workflow efficiency and, most importantly, boosts revenue by increasing collections and reducing bad debt and write-offs.
#2 – Capture Medicare underpayments that rightfully belong to your hospital
Almost half of all Medicare discharges are coded as transfer DRGs. While your hospital works to recover transfer DRG underpayments, it may not find 100% of them. Underpayments occur when the hospital discharges the patient as a transfer, but the patient doesn’t receive the ordered post-acute care.
It’s up to hospitals to identify claims that failed to transfer and recover payment. Thankfully, there are transfer DRG recovery solutions that can quickly capture underpayments and turn them into revenue, all with little effort from hospital billing and IT teams. Use a solution that not only automates the process of identifying transfer DRG claims, but one that directly connects to Medicare and the Common Working File (CWF), considered by Medicare to be the source of truth for claim data.
Hospitals with effective transfer DRG recovery programs typically use multiple services for a primary, secondary, and in some cases, a tertiary review. This ensures you capture as many underpayments as possible in a time when every dollar is critical.
#3 – Put your organization’s data to work
Most hospitals have a large volume set of revenue cycle data that can provide insights and drive informed decisions. While 93% of healthcare executives say they are looking for improved data analytics, most are hampered by reliance on IT and analytics tools with limited capabilities. Find an analytics partner that takes the burden off your IT team and makes true business intelligence easily accessible and comprehensible.
What can hospitals specifically measure to find pockets of missing revenue? First, insights into your denials are a must-have. A denial analytics tool can identify root causes of denials and solve your biggest challenges associated with denials:
Enable staff to identify denials before they happen
Streamline denial workflows
Automate the appeal process
Empower your team to identify trends and amend processes upstream
Second, by measuring your probability of returned payment, you can more accurately predict revenue and plan reliably based on your revenue stream. By predicting what claims are most likely to be paid, you can better prioritize. Intuition tells you to work your highest dollar claims first, but the key is to use data to align your limited resources to work claims that matter most. Analytics can reduce this bias and ultimately compresses your payment cycle.
Once you’ve scored claims that need attention, you must assign the correct team members to work them. Analytics can normalize payer data and provide other critical information to bring efficiency to your work queues. Using an analytics platform that examines reason codes and delivers actionable, prioritized data back into your systems makes your work queues smarter, helps you work claims faster and eliminates costly manual labor associated with reason code assessment.
With the right additions to your tech stack, you can fully harness the power of your data to empower faster, more actionable decision-making.
As the COVID-19 pandemic continues to unfold, healthcare organizations embracing modern technology will adapt more easily to shifting financial challenges while remaining focused on improving patient care. Visit Waystar.com to find out how your organization can collect more revenue—more efficiently—in 2021.
Price transparency in healthcare is top of mind for patients and providers.
With the Centers for Medicare & Medicaid Services (CMS) calling on hospitals to increase price transparency by January 1, 2021, it’s time to prepare for the mandate and get a handle on how your organization will meet this challenge.
Successfully making the transition to offering greater transparency will not only put your organization in compliance, but help satisfy patient demand, increasing patient engagement and even point-of-service payments. As you navigate these new regulations and a landscape where patient estimates become the norm, here are five stats to keep in mind.
1. 74% of consumers would rather pay $50 out of pocket than not know the cost of a primary care visit. 1
Not knowing the costs associated with a healthcare visit can make it difficult for patients to plan and prepare to pay. Patients don’t just prefer price transparency—they’re willing to pay for it.
2. 49% of patients say having a clear estimate of financial responsibility will affect whether they see a certain provider. 2
Offering price transparency may be the difference between whether a patient visits one hospital over another. The same survey indicated that, given an estimate at the time of service, nearly two-thirds of patients would be more willing to make at least a partial payment. Price transparency, therefore, plays a crucial role in determining where and if patients seek care—as well as what they are prepared and willing to pay up front.
3. 300: the number of common shoppable services for which the CMS rule requires hospitals to post pricing. 3
As your response to the mandate takes shape, it’s critical to understand the full extent of what it will require of your organization. It’s not just hospitals that are going to be affected by the CMS mandate—providers not subject to the rule will still need to remain competitive as patients become accustomed to greater transparency.
4. 150: the average amount of hours CMS estimates each hospital will spend to review and post their standard charges for 2021.
…And some experts suggest this projection is too low. 4 The bottom line is meeting this mandate is a real lift for hospitals, despite the many benefits it ultimately delivers to both patients and organizations. That’s why it’s so important to prepare by putting in place the processes and technology solutions that can make the transition as smooth as possible.
5. 60%: the amount Baylor Scott & White increased its point-of-service collections in its North Texas division since it started offering price estimates. 5
While answering the CMS mandate can feel like a burden, health systems that have already branched into greater price transparency have seen an increase in point-of-service collections. With the right approach, your organization can offset costs and strain on staff with tools that will help you grow collections and ease the administrative burden of transitioning to greater price transparency.
What’s next?
Regardless of whether your organization is subject to the CMS mandate, it’s clear that greater price transparency is the future of healthcare. The good news is provider-facing and patient-facing estimation tools are available across the continuum of care today. Waystar offers proven, automated and accurate solutions that are driving increased patient loyalty, greater point-of-service collections and reduced collection costs for organizations around the country. For more information about the mandate and how to prepare, visit Waystar’s price transparency resource center.
References: 1. 10 insights from the Primary Care Consumer Choice Survey, Advisory Board
2. 75% of Patients Look at Price Transparency Ahead of Care Access, Patient Engagement HIT, September 2019
3. Hospital Price Transparency Final Rule, The Medicare Learning Network, December 2019
4. Price Transparency Requirements for Hospitals to Make Standard Charges Public, Department of Health and Human Services, November 2019
5. Achieving transparency in healthcare, Modern Healthcare
This article is based on a recent webinar hosted by Waystar about how revenue cycle leaders can leverage technology to elevate self-pay revenue strategies—while improving patient satisfaction and making the most of limited resources.
COVID-19 has created serious macroeconomic consequences in addition to medical ones. By the end of May, more than 35 million Americans had filed for unemployment. This job loss has caused millions to lose employee-sponsored health coverage and created a surge in self-pay patients. Those who have maintained their benefits are facing uncertainty about out-of-pocket costs should they seek care during this time.
For providers, it’s significantly harder to collect outstanding patient balances after the point of care, particularly after ER visits and inpatient admissions, which have accounted for many in-person care episodes during this crisis. In fact, according to the Academy for Healthcare Revenue, providers have only a 30 percent chance of collecting post-service compared to 70 percent at the point of service.
In June, Waystar hosted a live webinar on how hospitals and health systems can handle the needs of a growing self-pay population. Below are the four pillars of success outlined in that webinar. You can also watch the full webinar on demand here.
1. Expand your patient engagement channels and keep the lines of communication open
It’s important to meet patients where they are and create a seamless financial journey for them, from pre-service to adjudication. Communicating early and often about their financial responsibility—on the digital channels patients prefer—translates to more self-pay revenue. Many people now toggle back and forth between computers and smartphones, so it’s important to offer both communication and payment options on a multi-channel basis. From automated emails and text alerts to user-friendly estimation tools on your website, it’s never been easier to reach patients quickly and easily across devices. What’s more, flexible, digital-based outreach can often replace phone calls and standard mail, which can be a huge drain on resources.
2. Know your patients
The more you know about your patients, the better you’ll be able to communicate with them to more efficiently collect payment. For example, leveraging predictive analytics can help you forecast a patient’s likelihood to pay, the expected cash value of their account or if they qualify for financial assistance. When you consider that about 35 percent of patient balances are self-resolving and 30 percent of bad debt can be classified as charity care, what billing team wouldn’t benefit from that guidance?
Additionally, predictive analytics can help determine the ideal volume and frequency of outreach at the individual patient level, eliminating unnecessary touches some may find irritating. The right tool can also facilitate smarter resource allocation and cut third-party collection agency fees by highlighting accounts with a lower cost-to-collect that should be kept in house.
3. Personalize patient financial engagement
With a greater sense of a patient’s financial state, coverages and communication preferences, you’re in a better position to improve patient satisfaction and use resources as needed. The market’s best solutions score and segment patients based on account balance, propensity to pay and many other factors, and generate a recommended outreach plan. Research shows patients are most motivated to pay care costs prior to service. As such, many providers are choosing to establish flexible and tailored payment plans prior to care to give patients more financial clarity and flexibility.
4. Focus your staff where they’re needed most
With the right tools in place, patient payment can be simple. Leverage technology across the patient journey so you can deploy valuable resources and staff time where they’ll go the furthest. Predictive analytics can offer recommended workflows that increase self-pay collections. The right technology vendor should also be helping you track your self-pay collection performance via up-to-date dashboards and regular business reviews so you know how things are going and can identify opportunities for improvement.
The wrap up
We’ve all come to expect convenient, seamless payment experiences when purchasing various goods and services in our day to day. Spurred by the surge in self-pay patients brought on by COVID-19, rev cycle leaders are making strategic investments to create streamlined, multi-channel patient engagement ecosystems, designed with the needs of patients and billing teams front and center. When communicating with patients about payments, reaching them at the right time and with the right approach contributes not only to improved collections, but to patient loyalty and stronger patient-provider relationships.
Click here to learn more about how Waystar can help your organization follow the best practices outlined above, respond to rising patient consumerism and ultimately bring in more more revenue.
This article is based on a recent webinar hosted by Waystar about how revenue cycle leaders can support patients, payers and fellow team members during these difficult times.
Waystar has put together a comprehensive COVID-19 resource center to connect providers with information about coding and regulatory updates, telehealth guidelines, emergency waivers and more. Our team continues to gather and author resources that can help revenue cycle teams and healthcare professionals navigate this crisis.
The spread of COVID-19 in the US has dramatically altered the healthcare landscape. We’ve seen mass cancelations of elective procedures and widespread shortages of PPE. Telehealth adoption has exploded, and entire administrative teams are working from home for the first time. From major health systems to small primary care practices, providers of all kinds are facing tremendous headwinds—many never seen before—and doing their best to adapt.
Patients are also experiencing challenges and uncertainty about what’s ahead for them. Like providers, patients are adjusting to telehealth and reduced face-to-face physician encounters, and trying to stay up to date with the latest from their health plan(s). The economic fallout and job loss brought on by COVID-19 has had immediate health coverage implications for millions of Americans. As unemployment figures climb, so do self-pay patient populations.
For revenue cycle leaders, efficiently managing operations and patient engagement is crucial right now. Here are a few ways you can create more financial transparency and flexibility for your patients, while easing the administrative burden on your team.
1. Leverage coverage detection technology
Often in emergency cases, which account for many COVID-19 admissions, insurance information isn’t collected until after discharge. With unemployment figures as high as they are, many Americans have recently lost coverage. They may have enrolled in the Exchange, secured public assistance or plan to file for COBRA after they’re discharged. Because patients may be unable to furnish insurance information at the time of admission, an automated coverage detection tool can help rev cycle teams identify active coverage patients may not know they have, reducing unnecessary patient touchpoints and needless work for your staff.
2. Automate charity care screening
With billions of federal aid earmarked for COVID-19-related treatment of the uninsured, strong charity care screening practices are critical. Undertaken manually, financial screening is time-consuming and cumbersome, and patients can fall through the cracks. With an automated solution, you can easily identify those who qualify for assistance and avoid sending them to collections or writing off their care as bad debt. Thorough, fair financial assistance evaluation also contributes to higher patient satisfaction by limiting unnecessary engagements.
3. Adapt to telemedicine with eligibility + estimation tools
Not surprisingly, telehealth adoption has exploded in the wake of COVID-19. In fact, the volume of telehealth claims on the Waystar platform grew by 50 times since the start of April. Providers have pivoted to telemedicine to monitor COVID-19 patients and conduct routine wellness visits. More and more patients are making use of these technologies, but some remain confused by associated out-of-pocket expenses.
The industry’s best eligibility tools pull the latest coverage information and contracted rates from thousands of payers so you can easily determine if these services are covered by a patient’s plan. What’s more, you can deliver an accurate estimate of their out-of-pocket responsibility so they’re able to make informed decisions about their care and be sure they won’t receive surprise bills down the road.
4. Bolster digital engagement
Provide a safe, convenient patient financial experience with digital communications and online payment portals. Sending statements and balance reminders by text and email is faster than standard mail and allows patients to view up-to-the-minute balances and make payments online across devices.
The wrap up
Rules and regulations surrounding COVID-19 treatment are in flux, and that has a direct bearing on patients’ insurance coverage and financial responsibility. It falls on healthcare providers and their technology partners to make sure administrative teams are equipped to guide patients through the uncertainty of COVID-19 and help them weather the storm.
While front-line providers and support staff continue to serve patients, many rev cycle personnel are working remotely for the first time, which presents its own set of challenges. For more ways to strengthen revenue cycle operations and empower your fellow team members, check out our recent blog. With simple solutions and adjustments, you can take some of the stress out of this transition and position your organization well for what’s ahead.
Waystar explores how innovative tech is bringing needed transparency and consumerization to a patient financial experience marked by surprise medical bills and growing out-of-pocket costs, while also helping providers improve key administrative processes.
The US healthcare system’s lack of price transparency is perhaps the single biggest issue plaguing the patient financial experience. Across care settings, patients receive treatment with little sense of out-of-pocket costs and what will ultimately be covered by their insurance. And when bills do come, they’re often higher than expected, difficult to understand and unpredictably timed.
Surprise billing on the rise
This lack of financial clarity, paired with the fact that patients have to shoulder a higher percentage of care costs under high deductible plans, often leads to surprise medical bills following inpatient hospital visits, emergency care, lab tests or other care episodes.
According to a 2019 JAMA study, there’s a growing possibility patients will be billed by an out-of-network provider even when they go to an in-network hospital for care. And, these unanticipated bills are only getting more expensive.i In a survey conducted last fall by national consumer group Families USA, nearly half of respondents (or someone in their family) had received a surprise out-of-network bill. More than 75% of those people were charged at least $501—no small sum for many households.ii
The burden of confusing pricing and surprise bills isn’t just felt by patients. As we shift toward value-based reimbursement models and patients take on increased responsibility for their healthcare costs, providers are overhauling their self-pay collection strategies. After all, it’s in providers’ best interest financially to make sure patients receive a clear, convenient consumer experience. What does that look like? Clear price estimates ahead of care, timely billing cycles, flexible, digital-friendly payment options and more.
How to tackle price transparency
Fixing this surprise billing problem has received widespread bipartisan support. While new legislation is crucial to fixing this problem, better revenue cycle management technology is also critical. Providers of all kinds need reliable tools that give patients a better sense of out-of-pocket expenses—solutions that bring clarity and speed to payment processes so patients can take a more proactive, informed role in their care. With the help of AI and other disruptive technologies, billing is becoming a more consumer-centric experience.
One such tool is an online price estimator we implemented at Georgia-based University Health Care System. Originally developed by our most recently acquired company, this tailored estimation tool allows patients to easily generate an accurate approximation of out-of-pocket costs for a given service. All they have to do is access the University website and provide some basic information about their coverage, the type of procedure they need and their preferred facility.
The upside for providers
University has found patients are more willing to pay at the point of service when they have a clear sense of what they owe out-of-pocket. In fact, they’ve seen upfront payments improve by 50% in just a few years.iii What’s more, their billing office has been able to limit manual workflows and gain better insight into how much patient-pay revenue they can count on. For non-profit facilities that need to meet certain charity-care requirements, tools like this can help significantly reduce bad debt.
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Opaque pricing and billing practices prevent patients from making informed financial decisions and can result in crippling unforeseen bills. Fortunately, innovative solutions powered by AI and robotic process automation are already being deployed to streamline prior authorizations, generate cost estimates and simplify the financial screening process. Explore some of our most popular solutions here.
But, innovative tech is just one piece of the price transparency puzzle. Payers and health IT vendors must strive for better interoperability. Policymakers must set billing rules that serve both patients and providers. And, providers must strive to deliver the same level of clarity and convenience patients have come to expect from other consumer-facing businesses.
iAssessment of Out-of-Network Billing for Privately Insured Patients Receiving Care in In-Network Hospitals, JAMA Internal Medicine, August 2019
iiSurprise Medical Bills National Survey, Families USA, October 2019
iiiProviders innovated patient engagement and experience in 2019, Healthcare IT News, December 2019
Providers are much more attuned to the importance of digital engagement and creating a positive patient financial experience before a patient ever steps through the doors for service.
According to Heather Kawamoto, VP of product strategy at Waystar, in a post-COVID-19 world in which tech giants and consumer health companies are vying for the same patients as provider organizations, having accurate pre-service information is vital to making this happen. “Automation is the best way to get there with fewer resources,” she says. Below, Kawamoto discusses how technology tools alleviate manual work across the revenue cycle and allow more proactive engagement with patients along their financial journey.
Q: What are the three most important actions that providers should take if they are looking to improve the patient’s financial experience?
A: The most important piece is first to step back and evaluate how they want to engage digitally with patients in the future. Patients’ expectations have shifted post-COVID-19. They want to engage with providers differently, having become accustomed to telehealth and the ease of Uber Eats and Amazon deliveries. Patient financial experience goals need to align with an organization’s larger patient-consumer digital strategy, especially as consumer-first entrants like CVS and Walmart make more inroads into healthcare and draw patients away.
Second, it is imperative to automate the patient’s financial experience. Given current resource constraints, including the labor shortage, providers cannot manually manage all of the work. They must choose an automation solution that best facilitates patient financial communications and collections. Finally, understanding patient demographics is essential to engaging more patients digitally and creating a positive financial experience. For example, patient communication preferences have changed substantially since the introduction of digital tools. Thus, providers will need to segment patient populations to identify communication methods that get the best response.
Q: When thinking about the patient journey, we often focus on the touchpoints in which patients actively participate. But what about other activities happening behind the scenes—such as eligibility checks and prior authorizations that also impact balances? Should providers consider this as part of the broader patient financial experience?
A: Absolutely. Legislation requirements make it critical for providers to communicate with patients as soon as possible during pre-service. Providers need to tell patients how much they can expect to pay out of pocket for their service and allow them to start paying or having a conversation. Organizations can differentiate themselves and increase loyalty by helping patients understand eligibility and prior authorization actions, which potentially impact the time in which a patient receives care.
For example, providers need to thoughtfully tell patients when a prior authorization hasn’t been secured ahead of their service and rescheduling is required. This eliminates surprises, which are a source of frustration for patients. Similarly, with eligibility, if a patient has multiple insurances, let them know and explain how you are managing the situation. That said, mindful use of technology and patient communications is key. Don’t overload patients with too much information, otherwise, they may start to ignore communications, which could impact upcoming services or their final patient responsibility.
Q: Realistically, nearly every provider is feeling the strain of understaffing. How can providers continue to improve the patient financial experience without creating additional work when they're already spread so thin?
A: When competing with other providers who make things easier for patients, it is critical to deploy more automation throughout the revenue cycle to manage workflows and scarce resources more effectively. Progressive providers now expect it will be a piece of just about every technology they buy. Automating critical processes and services allows providers to reduce friction across the patient financial experience and ultimately build trust with patients. For example, automating pre-service estimates and using analytics to segment them enables providers to push estimates to patients using their preferred communication channel and save resources by following up only with patients with a higher propensity to pay.
Q: Can you share examples of providers successfully improving the patient financial experience today?
A: Huntington Hospital is an excellent example of an organization that has seen phenomenal results with its thoughtful patient engagement strategy and rollout of patient payments. They engage patients with customized options and prioritize those with a propensity to pay to ensure they aren’t following up on bills that likely won’t be able to be paid. The Baylor Scott & White Health system in Texas is another organization that has been proactively engaging with patients for many years. They have their own mobile app serving up estimates and other information to every patient that services through one of their facilities. They are also very strategic about using their people to do outreach.
