Because getting ahead and staying ahead requires starting ahead
“We can’t keep up. We don’t have the staff to manage the rejected claims, or the ability to forfeit revenue.” The director at a large lab was sharing his concerns as he understood the challenges to ensure that every test be processed and billed correctly for payment, be it from an insurance company, the patient, or – in the case of COVID – the U.S. Health Resources & Services Administration (HRSA).
Unfortunately, this isn’t an unusual situation. While healthcare facilities have adopted technology in many facets of their operations, one area – ensuring accurate patient information, particularly for health insurance claims – has for many remained mired in the 20th century – with antiquated systems or paper.
Especially in these days of consumerism, understanding the patient is crucial. Patients’ demands for convenience, fast results, correct and timely bills, and information security are increasing. Knowing the right insurance and demographics, and the patient’s specific financial situation and propensity to pay, is key. If you are not capturing the right data up front, the potential for it to cause problems downstream is equally likely. The result? A hit to your bottom line both from lost reimbursements and patients taking their business elsewhere.
Inaccurate or missing patient information is not new. It has been an issue for years and continues to persist during the pandemic. According to the Journal of American Health Information Management Association (AHIMA), about“40% of patients’ demographic data are missing from commercial laboratory testing for COVID-19.”
Instead of sticking with the same old ways of doing things or spending time fixing issues at the back end, the better strategy is to use technology to catch and fix errors at the start – that is, to collect the patient data up front and run it immediately through an automated process that confirms their address, insurer, specific plan, and co-pays. This will save you time and money and allow your facility to focus on delivering more patient-centric care. By knowing the right insurance and plan for patients upfront, whether HMO or PPO, some labs even choose to route specimens to different facilities.
Upfront information verification can also support efforts to offer new services such as telehealth, an area spurred by the pandemic. The U.S. Centers for Disease Control and Prevention reported a 154% increase in telehealth visits the last week of March 2020, versus the same week in 2019. Research from McKinsey & Company found that over 46% of consumers now regularly use telehealth, up from 11% in 2019.
If a physician group wants to offer telehealth services, they might use a platform for patients to register for the appointment online and add their demographic and insurance information. But the docs at this practice could do better if the solution also instantaneously checks the patient’s information to either verify, fix, or flag it for further review. They would then have accurate patient information before the person’s appointment.
Upfront information verification can also support new offerings like at-home lab testing kits. Imagine the patient scanning the QR code on their kit which enables them to enter their information, and then having the software instantly cross-check the info and surface any potential errors to be fixed on the spot.
Or imagine a more urgent situation: a patient in an ambulance. Enroute, the patient’s accurate demographic, insurance, and financial information is captured and provided to the hospital through integration with their patient records system to help avoid a delay on arrival.
Automatic data verification at the start can make the whole process, whether in-person or virtual, smoother for administrators, clinicians, and patients. By removing bottlenecks to find or verify patient data, they’ll benefit from an expedited process and focus on what’s most important: the patient’s care.
While we know the patient’s health is the main goal, your ability to stay lean and be efficient is also positively impacted by upfront data verification. With bad or no data, your staff may spend valuable time making phone calls, waiting on hold, digging for information, and ultimately questioning the value of the claim they are working on and perhaps dropping it altogether. All the time they just spent is ultimately wasted and adds little or no value to your bottom line.
Having an automated and repeatable process to get valid patient data upfront puts you ahead of the game. It gives you flexibility to handle fluctuating volumes and offer a full compendium of services without affecting your administrative staffing levels. Early verified data also ensures a positive patient billing experience without surprise bills that might otherwise also cause frustration for the referring provider and result in a loss of business. And lastly, that good, clean, and early available data ensures you are ready to manage the unexpected.