By Evereth Woodruff 
At the heart of some of healthcare’s most deeply rooted billing and patient experience issues is front-end data collection. At the same time, front-end data collection is at the heart of patient access to care.
Outdated technology, manual processes and chronic staffing shortages are now paired with patient expectations for better access, accuracy and convenience. In fact, patients often face challenges before they ever see a doctor due to data and information discrepancies like insurance verification issues and errors in their medical records or billing information.
How do healthcare organizations combat these persistent hurdles and improve patient access? Investment in the right technology. Providers can leverage technology, automation and artificial intelligence (AI) to:
- Enable patients to better understand their insurance coverage, better understand their costs prior to care, and better prepare for how to pay for it.
- Improve patient service levels and simplify appointment scheduling, check-in, and registration.
- Reduce labor costs while addressing staff shortage and turnover issues among front- and back-office jobs by automating once-manual and labor-intensive roles.
- Prevent avoidable claim denials related to incorrect or incomplete information being captured, ultimately lowering the cost to collect and accelerating payment cycles.
Inefficiencies in patient access
Inefficiencies are an unnecessary barrier to patient access. Manual workflows that burden staff, absorb valuable time and allow for human mistakes result in data entry errors and denied claims, which negatively influence the rhythm of the entire system.
Front-end healthcare staff (the registrars that patients first interact with to provide their personal information and insurance) have been facing a higher turnover than in previous years, largely because of low wages, a manual workload and the pivotal role they play in the patient experience. According to the U.S. Bureau of Labor Statistics, the median annual wage for medical registrars and health information technologists is $67,310, with about 3,200 projected openings each year and growing. Many of those openings are the result of needing to replace workers who either exit the labor force entirely (such as to retire) or who transfer to different occupations, often for better pay and/or working conditions. In some areas, workers can find better paying jobs at retailers or fast food restaurants.
With new staff, there is time and energy dedicated to constant training, ultimately adding to experienced staff’s workload and clogging the system. Human errors, such as inaccurately entering patient data, are common under these conditions and have a higher likelihood to occur.
Additionally, during registration, if a patient’s insurance is not verified or if the patient is self pay, the registrars will need to manually try to find additional coverage. This process is prone to the same errors of inaccurate data entry, as well as the burdensome process of manually checking multiple sources.
Ultimately, these errors can result in claim denials, which become a major pain point for both providers and patients. In fact, claim denials are on the rise and one of the primary causes of denied claims is patient information errors. Too often, claim denials are viewed only as a financial problem for providers. However, these claim denials impact the patient journey as well, sometimes leading to unexpected out-of-pocket costs and delayed or entirely skipped medical care.
Overall, these inefficiencies are major roadblocks to increasing patient access.
Confusion in patient access
Another issue hindering patient access is misalignment between providers and patients. For patients, “access” is often associated with control over their personal medical information. For example, being able to easily view medical records, test results, appointment schedules and even communicating with their healthcare professionals within a portal. Access to patients is synonymous with transparency and convenience.
Providers think more logistically and operationally. They often consider patient access to mean appointment availability and insurance coverage eligibility and verification. The ability for a patient to be seen by the right provider in a timely manner with no logistical hiccups. Providers associate access with efficient workflows and compliance with all the necessary, and ever changing, payer requirements.
In order to bridge the gap, the industry needs to address both sides of the equation of operational efficiency and a transparent patient experience.
Start with step one
The first step in bettering patient access is looking at the patient’s first step.
Errors and inefficiencies at the front end, when the patient first walks in the door, affect the entire revenue cycle management (RCM) process. Most notably, inaccurate patient data contributes to claim denials, which leads to revenue loss. Providers acknowledge that a significant amount of data collected at registration and check-in contains errors and recognize that those inaccuracies are a primary cause of denied claims. Frustrating roadblocks in RCM including cash flow issues and increased accounts receivable days, as well as compliance risks and operational issues are the result.
While disruptions in RCM largely affect the provider’s bottom line, it directly affects the patient’s experience as well. Outside of claim denials, inaccurate patient data entered at registration causes patient dissatisfaction through delayed reimbursements, billing errors and unexpected charges. Patients can even face challenges before they ever see a doctor due to data and information discrepancies, with some experiencing care delays due to insurance verification issues and encountering errors in their medical records and/or billing information.
Additionally, the accuracy of cost estimates is declining. While the inaccuracy can be attributed to several factors — complexity of insurance coverage and evolving payer rules — a significant challenge is capturing comprehensive patient information upfront.
Modernizing with AI
While the healthcare industry is far from full adoption of new technology and AI, organizations have seen how it drastically alters the process by relieving manual workload burdens and preventing hiccups that deter operational efficiency.
For example, automation technology can verify insurance and eligibility, predict errors before a claim is submitted, reducing the chance of denial and if an error is made, catch and flag it. The right technology uses “if-then” logic that returns multiple data points from a single inquiry. It can be leveraged to capture and process patient insurance data at registration, ultimately collecting and verifying much of the information needed to compile an accurate claim. Additionally, it can automatically identify active secondary and tertiary coverage information to eliminate coverage gaps and fix patient identifiers so patients don’t miss out on essential support.
From scheduling and registration to cost estimation and claims management, the right technology has the power to transform how both providers and patients experience healthcare.
When these processes are supported and streamlined with automation technology, not only does the burden on staff decrease, the overall RCM process is more seamless, resulting in a healthier bottom line for providers and a more consumer-friendly experience for patients.
Plan forward for change
With all the roadblocks providers are facing to better patient access, where do they start?
Providers begin by looking at the big picture — mapping the patient journey end to end. Gather feedback and identify friction points for both staff and patients. Where are the biggest challenges hindering a streamlined workflow?
Then, prioritize. Providers can’t tackle the entire RCM process at once. Determine where to place energy and effort based on impact. Which area of the process will have the biggest impact for the bottom line and for patient access.
Finally, invest. Research which technologies integrate into the current electronic health record (EHR) platform and invest in scalable technology that will automate processes and provide a seamless workflow for the organization. Then, measure the results and determine what’s working and what comes next.
The healthcare organizations that will see positive change are the ones that invest in the tools that will support true patient access.
Photo: erhui1979, Getty Images
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