The Executive Suite: Revenue Cycle Best Practices for Patient Accounts Receivable

Stepping into A/R

Accounts receivable (A/R) for healthcare practices include many facets and nuances. The overall A/R process constantly evolves with numerous challenges. While we may not consider A/R challenges as ultimate determinants of success, improving the time in A/R can be a game changer. According to an MGMA Stat poll, “56% of medical groups say their time in A/R increased in 2022,” while “top challenges in handling collections and days in A/R among those who responded included” items such as:

Challenges in billing and collections
Increases in prior authorizations
Increases in requests for documentation, coding, or even review notes
More time to understand the EHR
Or problems with credentialing

Navigating the A/R landscape from challenges to solutions can revolutionize your practice. With Greenway Health’s guidance, let’s delve into workflows, patient education, patient costs, financial policy, and how these work together to formulate the science of best practices in A/R.

Mastering workflows

Healthcare providers in the front office must thoroughly assess these areas before the patient’s arrival and pose a crucial inquiry: Have you thoroughly analyzed your front office workflows? The front office and its efficiency impact all operations within a healthcare group. This group of employees is the voice and the face of the practice. Connecting with patients and getting to know them is critical. The patient experience evolves with significant initial interaction with patients through the front desk. Moreover, the front office staff are ambassadors to the practice's success.

Likewise, for 78% of healthcare quality experts, improved clinical workflow and efficiency are the keys to boosting health information technology quality, according to a recent survey from the American Society for Quality (ASQ) survey.

Accurate information from insurance to demographics starts at the front desk check-in process. The front office worker should ask for communication updates on the policyholders, policy IDs, preferred communications, and patient portal access before check-in processes. For existing patients, front-office workers need to verify primary, secondary, and tertiary insurance (such as Medicare or supplemental), ask about coordination of benefits, and information entered on the patient’s demographics page is used for insurance claims. Check-in and collecting outstanding bills at the front desk before being seen give the patient and the physician a strong and trusting start.

As a best practice, always rerun the insurance availability at least two days before the appointment. This check ensures no surprises, and the process for check-in can go smoothly.

At this time, obtain as much demographic information as possible when scheduling a new appointment. Revenue leakage can happen anywhere in your revenue process, ruining the cash flow.

Importance of patient education

Along with workflows, patient education, and economic responsibility also play critical roles in revenue streams. Firstly, patient education is essential to ensure that individuals are well-informed about their health, conditions, and treatment options. Armed with comprehensive information, patients feel empowered and can make informed decisions. When patients are involved in their health, they can better adhere to treatment plans and will achieve better results.

Secondly, physicians, healthcare organization leaders, administrators, and front office staff need strong leadership qualities to educate and inform all patients. Healthcare IT companies can increase revenue and promote a practice’s staff members’ leadership qualities by prioritizing training for staff and educating their patients. Consequently, within a piece published by MGMA Insight Article from September 2022, “Providing educational content that focuses on leading self, managing relationships, acquiring business acumen, as well as learning how to integrate this knowledge into practice can be beneficial.” Education and leadership training can be powerful tools for building process improvement, project management, and effective business plans.

Unveiling patient costs and accountability

In current months, the trends point to patients delaying payment of medical bills due to high deductibles in their health plans. This change leads to practices forced to act as a creditor to collect payment and patients looking for multiple options such as pay by mail, pay by phone, easy recurring payments, using cards on file, online income, mobile pay features, and financing.

Two conversations must occur. First, the office must commit to transparency, ensuring the patient knows the financial responsibility beforehand. The patient’s outstanding balance and commitment should be communicated before the visit, along with the upcoming billing charges to appear for the visit. Secondly, before the visit, education and transparency inform the patients that the cost of their services may vary based on specific services. Always start higher than expected for payment plan options. Provide a list of the expenses but allow time to discuss how the costs may vary. Another best practice is always providing financial assistance program information if needed. The front office will need to be ready to discuss these topics.

Patient balances from previous visits should include discussions on specific services and associated costs, starting with higher than you expect and negotiating down with details on financial assistance programs.

The patient’s responsibility and older balances include difficult conversations; thorough discussions on professional, polite, and compassionate information, without judgmental or accusatory tones, communicated with the patient is the goal.

Financial policy tips

Financial policy is a daily operating procedure and should be understood well. Proactively informing the patient before they see the physician is the best way to be upfront and honest with the patients. When writing this policy, it is essential to use language that patients can easily understand and avoid using technical terms or jargon commonly used within the office. Another benefit of a solid financial policy is that you do not become a creditor; payment plans are well-designed and straightforward.

Manage and monitor your accounts, as there may be data entry errors. Remember to review patient aging reports regularly and have set days to check the patient balances. If these steps are only partially successful, partnering with an agency for severe debt collections is always possible.

Moreover, another vital aspect of financial policy is best practices for patient statements. The quick items list a phone number for billing questions, which does not include the balance aging on the account and does not show credits. Reasons include some patients viewing aging on the statement as “more time to pay” and credit may confuse the patient. Overall, it is advisable to review financial policies every six months.

Final implementation of best practices

Efficient workflows and a trained staff reduce costs, and your highly qualified staff builds trust and respect with your patients. Thorough implementation of some best practices is a starting point to effectiveness and increasing patient accounts receivable. Remember to review other sources of inefficiency to boost revenue and follow the best principles outlined by your revenue cycle manager. Demystifying and clearing up confusion inspires us all.