Patient-Centric Revenue Cycle
The major processing steps required for a request for service through closing the account at zero
... [Show More] balance.
Pre-Service
Scheduled & pre-registered pt.,cost est., data colleted
Time-Of-Service
Scheduled & Unscheduled-caser mgmt. & discharge, consents, pt is id'd, copay & amt collected, pre reg record activated.Unsched pt have comprehensive regis & financial processing
Post-Service
After pt is discharged-bill to healthplan, pt account monitored until payment reaches zero
Healthcare Dollars and Sense
Name given to the 3 HFMA revenue cycle initiatives:
Patient Financial Communications
Price Transparency
Medical Account Resolution
Patient financial communications best practices purpose & principles
· All patient financial interactions
· Emergency department
· Advance of service
· Time of service (outside the emergency department)
· Measurement criteria framework
Best Practices for price transparency
As part pf the consumer driven programs, patients need pricing information to make informed healthcare choices in hospitals to inquire about costs and fees prior to agreeing to service.
A. Required information for pricing include: type of hospital service (based on CPT/HCPCS or MS-DRG code), patients' health plan and/or benefit plan
Medical account resolution
Educate, bills, policies, consistency, coordinate, judgement, timing, report and track
Financial Counseling
If appropriate, patient is referred to for financial assistance. Typically patient share, prior balances, balance resolution
Typical elements of financial discussions
Including provision of care, registration, insurance verification, and financial counseling (patient share, prior balances, balance resolution)
Provision of care
The patient to make mutually acceptable payment arrangements to resolve outstanding balance. Ability to pay will not interfere with treatment.
Balance resolution
Discussions may occur concerning prior balances that are being handled by collection by provider, a collection of agency, or other organization
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Price transparency
On Health Insurance Marketplace / Health Insurance Exchange have consumer cost sharing requirement. Patients expect clarity & communication of costs, helps consumers make smarter decisions about care received.
The need for Pricing Transparency
Patients need pricing information, key info needed are type of hospital service on CPT or MS-DRG code, patients health and benefit plans
Medical Account Resolution
HFMA partnered with ACA (Association of Credit & Collections) along with others to work on medical debt task force.
What are the Medical Account Resolution Best Practices
Educate, bills, policies, consistency, coordinate, judgement, timing, and report & track. (See diagram)
What option is NOT a main HFMA Healthcare Dollars and Sense revenue cycle initiative?
Medical account resolution
Process compliance
Price transparency
Patient financial communications
Process compliance
Patient Satisfaction Metric with in the Industry (HCAHPS)
Hospital Consumer Assessment of Healthcare Providers and Systems
From patients perspective, CMS implemented value based purchasing program that focus' on core measures, one of which is HCAHPS. Objective is to provide a standardized method for evaluating patients' perspective on hospital care.
CMS implementation of value-based purchasing
HCAHPS
Objective of the HCAHPS initiative
Provide a standardized method for evaluating patients' perspective on hospital care.
HCAHPS Survey
27 questions related to clinical care and patient engagement - one question for all of satisfaction "Would you recommend this hospital to your friends or family?"
Importance of the survey to the hospital
Question on survey that asks "Would you recommend this hospital to your friends and family?"
Rev Cycle Team Members role in Patient Satisfaction
Leadership and staff must always remember 3 talking points:
Implement, Educate, Communicate
How do you improve the overall patient experience
Requires revenue cycle leadership and staff to simultaneously be inquisitive, responsive, innovative and flexible.
What is the Revenue Cycle Team members role in patient satisfaction?
Implement - processes that are patient-centric & efficient, especially in registration, admitting and financial counseling. (Positive first impression)
Educate - patients about insurance coverage & meaning and amount of copayments, deductibles, and coinsurance. (Can alleviate discomfort or concerns on payment expectations).
Communicate - financial information clearly, consistently and timely (prices estimates, financial assistance options, early pay discounts) in supporting "Transparency". [Show Less]