10 Steps to Create a Customer-Focused Revenue Cycle

10 steps to enhance patient loyalty, streamline processes and improve financial outcomes

In the new era of U.S. healthcare, as employers and payers reduce their coverage costs, the patient share of medical bills is steadily growing. As a result, the patient role is shifting from passive care participant to active self-advocate. Empowered by rapid advances in technology and ready access to information, patients today are rigorously evaluating healthcare providers, care options and plan choices before they receive services.

With patients having more options and more control over their decision-making, healthcare providers may find it more difficult to cultivate patient loyalty. In response, providers are proactively evaluating and scrutinizing all patient interactions. The goal is to improve the patient care experience by addressing the primary wants of today's savvy consumers: value, convenience, accessibility and personalized options.

A key avenue for creating customer loyalty, and gaining an edge in an increasingly competitive marketplace, is found in the revenue cycle. In the continuum of provider-patient interactions, revenue cycle staff members often have some of the first, last and most lasting exchanges with the patient — from scheduling and registration to billing and customer service. As a result, the revenue cycle can be pivotal in establishing each patient's overall experience of the provider's performance, opinion of the brand and likelihood of becoming a repeat customer.

Meeting the challenges
Historically, providers' patient-facing operations have focused primarily on clinical interactions, while revenue cycle interactions have been handled as a business-to-business process between provider and payer. Today, however, the patient has emerged as a central player in the revenue cycle equation, requiring providers to rethink and redesign core revenue cycle processes to become more consumer focused.

At the front end of the revenue cycle, patient scheduling, pre-registration, registration and insurance verification drive much of the downstream claims process. Missing or inaccurate patient information at the cycle's starting point can lead to revenue loss at its ending point. According to a study by PNC Financial Services, one out of five claims submitted is delayed or denied by insurers, and 96 percent of claims must be resubmitted at least once. Securing accurate information at the front end of patient visits can prevent delays and denialsand enhance patient satisfaction with their care experience.

The back end of the revenue cycle poses an equally significant set of challenges. Patients often don't understand their benefits or the bill they receive. Many providers do not have a single point of contact for billing information, often overwhelming patients with multiple communications and unclear information. Billing statements can be difficult for patients to interpret, and balances due may be a surprise because eligibility and coverage were not fully understood or communicated at the time of scheduling, registration or discharge. For patients, these challenges can lead to hassles and less likelihood to pay. A recent TransUnion survey of patients who reported paying a bill late or not at all finds that 75 percent were surprised by the out-of-pocket expenses for which they were responsible. For providers, such situations result in redundant and costly collection efforts and ultimately, lost revenue.

What patients want
In preparing for and receiving healthcare services, patients want certainty, convenience, timeliness and transparency. They want to communicate with their provider on their own terms, through the channels that best suit them. Patients also expect a convenient scheduling process, short wait times, clear communications, and the ability to easily view and change their appointments. A coordinated streamlined registration process, one that does not require iterative updates by multiple parties, is also high on the patient want list. And, as more financial responsibility shifts toward patients — with co-insurance, co-pays, deductibles and payment for non-covered services — they want to know their estimated balances upfront.

Rethinking and redesigning
From offering online patient portals to issuing easy-to-understand bills, the revenue cycle presents a distinct opportunity to make the transactional side of healthcare more satisfying for patients — and more financially sound for care providers. The goal is to transform the process from reactive to proactive, from one that begins after the patient receives care to one that starts with the patient's first interaction with your organization. Here are 10 guidelines for infusing a patient-centric approach into your revenue cycle:

1. Communicate with patients early and often through their preferred method of communication. Proactive, tailored communication is the foundation for improving patient interactions throughout the revenue cycle. As you build relationships with patients over a series of interactions, develop a patient profile that includes their communication preferences along with their demographic and insurance information. With this information you can target and relate to patients more effectively and deliver a more personalized experience.

2. Answer patient questions before they arise. First-time patients at your facility will likely arrive with many questions. Through electronic information pushes, you can instruct patients about what to expect as part of their experience with your organization, from where they need to be on the day of service to what they need to bring to their appointments. This simple step can significantly reduce patient anxiety and decrease the no-show rate.

3. Empower patients through self-service tools. Optimize patient engagement through patient portals, scheduling apps and registration kiosks. Studies have found that 90 percent of patients report that they want to use self-service features to schedule and manage appointments at their convenience. Through an online portal or mobile apps, your customers can self-schedule, check in, register and view their account virtually. Patients can also be provided with the opportunity to complete these tasks at an on-site kiosk, similar to the process for airline or hotel check-in.

4. Collect patient feedback and act on it. Hospital patient satisfaction surveys often lack enough useful questions about the patient's experience with revenue cycle activities. Periodically collect your own customer feedback through targeted surveys via telephone, email or the patient portal. This insight will allow you to focus on continuous improvement efforts that will make a difference for your customers.

5. Design patient scheduling with patient convenience as the focus. Work to create customized, convenient appointments for your patients. Organize scheduling staff so that they can schedule multiple appointments associated with a patient's care plan on the same day, with the appropriate amount of time to arrive at each appointment on time.

6. Drive ongoing improvements in processes and patient communications by capturing and leveraging historical encounter data. Analyze historical data to identify issues that may lead to hassles for patient, such as denied claims, incorrect demographics, incorrect addresses, or the wrong amount collected at time of service. Use analytics to identify trends and root causes, then provide feedback to revenue cycle staff members who made errors that led to these break downs.

7. Understand your patient population's propensity to pay. Segregate patients by their likelihood to pay before an appointment, immediately after an appointment, or in the iterative billing stages after they leave the facility using software tools. Tailor your collection activities to reflect each situation or to identify a patient's need for financial assistance. This step will pave the way for a personalized approach to collections, as well as increase the likelihood of customer satisfaction.

8. Keep patients informed of, and prepared for, their financial obligations. Provide patients with an estimate of their financial obligations as soon as possible — at the time of scheduling when possible. Offer iterative updates before discharge to prepare patients for the bill they will receive. Creating a meaningful estimate often requires using software that combines the patient's benefit information with the estimated charges for the scheduled service, based on historical charge data. It is also helpful to share information about the billing timeline and collection policies with patients prior to or at time of service.

9. Make the billing process consumer-friendly. Tailor billing statements to focus on what is owed and include your own explanation of benefits. Offer patients multiple ways to pay prior to service, on the day of service or afterward, including by phone or on-line portal. This will improve convenience and increase the likelihood of collection.

10. Leverage a single patient database. Aim for an enterprise patient database that includes patient information, including demographics, insurance information and patient preferences that can be leveraged across all users of scheduling, registration, clinical and billing systems. This will limit the number of repetitive questions asked of patients and ultimately, create a more streamlined patient experience.

In the post-reform era, creating a positive patient experience is integral not only to building loyal customer relationships, but to maintaining a healthy cash flow. Putting the patient at the center of the revenue cycle brings an opportunity unparalleled to generate value today — and provide for viability tomorrow.

Andy Adams is a senior manager in Ernst & Young LLP's Advisory Health Care practice and is based in New York, N.Y. Kristen Vennum is a principal in Ernst & Young LLP's Advisory Customer practice and is based in McLean, Va. Follow Kristen on Twitter: @kvennum

The views expressed herein are those of the authors and do not necessarily reflect the views of Ernst & Young LLP.




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