As revenue cycle leaders look for ways to improve point-of-service collections, many are turning to technology to not only improve collection, but to reduce claim denials and create better patient satisfaction as well.
Patricia Consolver, senior director of patient access at Texas Health Resources, has seen this firsthand. During her 23-year tenure there, the system implemented a technology platform that records authorization phone calls with insurance companies for use in denial management, which met with great success.
In 2013, the platform was expanded to support the system's patient experience strategy, and began capturing all of its interactions in the revenue cycle.
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"With 14 hospitals across a large geographic area, our goal was to standardize best practices throughout the revenue cycle for improved consistency and performance," said Consolver.
The platform enables Texas Health Resources to capture and integrate patient data from disparate sources -- voice, fax and electronic -- and form a more comprehensive view of the patient information that is exchanged across different departments. The recordings and documents are tied to the patient account, and can be retrieved through a web-based portal, or can be automatically exported to the system's electronic medical records.
Patient Access associates use this technology to capture each step of the patient encounter, from the physician's electronic order to payers' insurance verification. These associates record scheduling and pre-registration calls with patients, capturing details such as demographics and out-of-pocket estimates. On the day of the actual service, in-person conversations with patients are recorded using small desktop microphones hooked up to PCs.
The access is centralized, which means any authorized employee can securely retrieve the information contained in those records. They're all dated and time-stamped, and there's also a log of everyone who's accessed the information, creating a digital audit trail of sorts. That cuts down on the duplication of effort that sometimes takes place when grabbing patient info, Consolver said.
"Research shows that top performers in POS collections consistently provide complete patient obligation estimates prior to service, and attempt to make collections multiple times before care is delivered," said Consolver. "The platform has resulted in a more efficient authorization process with payers, helping us provide more complete patient estimates prior to service."
Having records of those financial interactions has also allowed the system to focus its staff training more effectively, and even make adjustments to the scripting. For instance, because final bills can sometimes differ slightly from their estimates, the scripting can change to reflect that so the patient is not blindsided.
"By reviewing interactions in sequence, we can ensure that patients receive consistent information at each touch point and identify any discrepancies or points of confusion," said Consolver. Financial communication between the system and its patients now has a defined set of best practices around it, she said.
While there was a cost associated with the implementation of this IT approach, the overturned denials and increased collections has provided more than an adequate return, said Consolver. And the platform itself was relatively simple to implement, requiring minimal involvement from the system's IT staff.
Building a culture of accountability around the platform was the most involved step; it involved creating a "quality scoring module" -- a scorecard, basically -- to gauge staff performance in areas such as tone and empathy. And employees routinely listen to their own recordings to tweak their performances and address any issues.
"More recently, we have focused on our management structure and training frontline managers (on) how to to conduct quality assurance," Consolver said. "We hold manager call labs where supervisors meet to discuss best practices for scoring employee encounters. An audio search function will also be implemented to search for exceptions to certain required phrases. For example, supervisors will be able to search for any interaction where an agent did not use a phrase to collect payment, or run a report to show the number of interactions where collection was attempted versus the number where it wasn't."
Consolver will be speaking about her system's efforts in-depth on Wednesday, Dec. 7 at the Revenue Cycle Solutions Summit in Boston.