The Healthcare Financial Management Association (HFMA) defines the healthcare revenue cycle as “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” The front-end part of the cycle manages patient-facing aspects, and the back-end handles claims management and reimbursement—each with its own departments, staff, and policies to drive revenue through the cycle.
However, the front-end (scheduling, patient registration, eligibility and authorization, and upfront patient collections) has a huge impact on the back-end’s success, so here are some front-end strategies that will improve the flow of the healthcare revenue cycle.
Patient registration and eligibility checks
After the patient is scheduled to minimize wait times and to ensure that patients have the appropriate time to meet their needs, the revenue cycle moves to registration and eligibility verifications. Staff uses the electronic health record or practice management system to record patient data, including demographics and insurance information.
Most important, staff should gather accurate information before a patient walks through the doors to lay the groundwork for billing and collecting claims in the most efficient and effective manner possible. They can prevent claim denials on the back-end by performing eligibility and authorization verifications.
Eligibility issues top the list of common reasons for claim denials, according to Medical Group Management Association (MGMA). Verifying information and completing prior authorization requirements is critical to avoiding claim denial. While providers should contact payers prior to a patient visit to ensure that services are reimbursable, staff does not always have time to wait on hold for customer service.
The quickest, easiest, and most accurate way to validate plan-specific benefits is with a cloud-based electronic eligibility verification system that integrates with the providers EHR system. Finding out real-time patient coverage effective dates, co-pays, and deductible information interactively with all payers in a single click saves an enormous amount of time:
- Eliminates visits to each payer’s website
- Eliminates having to mine pertinent information from lengthy payer responses
- Provides patient payment history
- Verifies billing address
- Improves efficiency and productivity of staff, leading to increased revenues
Upfront patient collections
With high-deductible health plans becoming more popular, patients are responsible for a significant portion of healthcare costs. Enabling front-end staff to collect copayments and deductibles helps reduce back-end collection efforts. One of the most successful ways to increase upfront collections is to offer an incentive for payment in full. A discount offered to the patient, if paid in full will limit back-end collections.
The front-end can help the back-end staff navigate the complex web of different payer requirements and mitigate claim submission and reimbursement challenges.