5 questions every RCM leader should ask to maximize patient payments

As personal choices continue to gain speed among patients, healthcare consumerism is a trend that continues to become mainstream for healthcare organizations seeking to give patients more choices to pay for care and manage their health.

Joe McMurray, senior vice president of patient experience with Zotec Partners, has seen this trend accelerate over the last five to seven years. “The patient has become one of the primary payers of healthcare,” he said. “Even though patients are vastly different from insurance payers with respect to their buying and paying behavior.”

Patients have more care options today. Additionally, as patients have become increasingly accountable for their medical bills, healthcare organizations have begun to shift to a retail-like patient experience. A recent McKinsey Consumer Survey noted with the onset of the COVID-19 pandemic, patients are replacing traditional care providers for retail clinics and virtual care options. According to the survey, 24 percent of the respondents had their last medical appointment through telephonic or virtual means. Additionally, only 4 percent of providers reported that they used telemedicine technology for follow-up care before the pandemic — in part because of a lack of parity in reimbursement compared with in-person healthcare.

“There’s no question patients across all age groups have become more comfortable and satisfied with alternative care delivery models, like telehealth, in the wake of the COVID-19 pandemic,” Mr. McMurray said. “These changes have also ushered in changes to the way healthcare is reimbursed, especially when it comes to payments from self-pay patients.”

Most healthcare organizations have some amount of bad debt resulting from self-pay patient balances. Even though organizations are starting to understand how to manage accumulated debt, preventing patient pay balances is the best way to collect on the hard dollars they might otherwise be losing. For revenue cycle management leaders to better connect with patients and support appropriate reimbursement, Mr. McMurray offered these five questions for consideration:

1. Who is likely to pay — patient or payer?

Ten years ago, the insurance provider covered a large majority of a patient’s medical bill, if not all of it. Today, patients are considered the largest payer population. They are accountable for a large portion of their medical bills due to the rise of high- deductible health plans, with an insurance deductible that may or may not be met based on the medical encounter. To get a handle on the trend, healthcare organizations should use tech-

enabled RCM to analyze each claim and determine who is most likely to pay right at the outset, ideally during time of service.

According to Mr. McMurray, Today’s most advanced RCM technologies feature eligibility and estimation algorithms to predict what the patient will ultimately owe. “Using predictive technology allows healthcare organizations to reduce downstream billing implications and collections,” he said. “Data makes it more likely for the patient to pay by obtaining as much of the patient’s responsibility as possible at the time of service and beyond, especially when patients are given multiple payment options.”

There will be patients who don’t receive a bill because insurance covered their service. However, for patients who do receive a bill, the likelihood of payment increases when they are given an easy-to-understand bill with a clear call to action.

2. How will payment communication be delivered to the patient?

As patients become more engaged with the financial side of the healthcare experience, they are requesting price estimates, logging into a portal to pay a medical bill, or calling their provider to learn about payment plans. Omnichannel outreach is a must. Reminders and payment options should be communicated in emails, text messages, paper statements, live service, chatbots, or recorded phone calls.

Patients who have inbound questions should have the ability to reach providers and their billing partners through an omnichannel experience that lets the patient decide what’s most convenient for them.

Email can now also be used as an effective way for providers to connect and collect. The email should contain a secure link to a personalized digital medical bill, with empathetic verbiage letting the patient know their options for paying the bill — whether it be payment in full or setting up a payment plan — and that the provider is available to assist with any questions they might have. Assistance can come in the form of chat representatives who can walk patients through the payment process right there or customer service staff who can assist via a phone call.

Mr. McMurray said effective omnichannel patient engagement offers a more flexible, customizable experience. “Patients who prefer to call in can get a representative on the phone, while patients who want a digital experience can log into a portal or platform to access their bills and options for paying them,” he said. “Meanwhile, patients who find they need more assistance after using one of these pathways can seamlessly transition to another.”

3. How will the payment be made?

Retail clinics and virtual care visits offer patients the convenience they want while also delivering more seamless, automated ways to pay using a laptop, tablet, or smartphone. Clarity is critical to how payments get made, and patients need clear instruction on their payment options which should include the ability to pay in full or set up a payment plan.

Contactless forms of payments have become more commonplace amid the COVID-19 pandemic. Providers can offer options like Apple Pay, Venmo, PayPal, and even e-check to make patient payment simpler and more convenient, offering a more retail-like experience.

4. What is the timeframe to receive the payment?

Healthcare organizations can take many approaches to project and decrease the timeframe to receive payments.

“Multi-staged patient interactions with omnichannel outreach methods can help clinicians receive patient payments faster,” Mr. McMurray said. “But employing RCM technology on the front end can also ensure clinicians are paid efficiently and appropriately.”

Processes for automated claims management and denial effectiveness can double the speed of collections. For instance, automated claims management can file directly with insurance carriers without the use of a clearinghouse. While highly efficient, doing this requires the organizations to have an in-depth knowledge of carriers in all 50 states.

Another way organizations can use RCM technology to minimize collections efforts is to perform a real-time insurance eligibility check for the patient during the time of service to

capture any potentially missing information that may not have been received from the facility. Newer innovations in RCM are solely designed to collect payment from self-pay patients. One such innovation is coverage detection that intelligently identifies and updates denied and true self-pay claims. Another innovation holds the claim long enough for the patient portion to be collected first before the rest of the claim is submitted to the carrier. Both yield faster payments, increase a patient’s propensity to pay and improve the patient experience.

5. How satisfied was the patient with the experience?

As bad debt write-offs and delayed patient payments continue to emerge as the top concern for hospital CFOs, it becomes increasingly important to improve visibility into the patient’s propensity to pay and minimize any frustration they have around their medical bills.

“Patients’ financial experiences with the healthcare provider are as critical as their clinical care experiences in terms of building greater patient satisfaction,” Mr. McMurray said. “Patient care doesn’t end after they’ve left the medical appointment, instead, it should end with patients thinking that was the easiest medical bill they’ve ever paid.”

As healthcare organizations continue to seek payment from scores of healthcare insurance carriers — and increasingly from thousands of individual patients who now populate the payer landscape — there is a need for an enhanced level of business sophistication in revenue cycle processes. Asking these questions and utilizing business intelligence tools and human expertise can help RCM leaders thrive in the new business-to- consumer healthcare world.

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