Many integrated healthcare delivery models, such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) aim to enhance patient care while reducing costs. One approach organizations can take to succeed under these care models is consolidating and centralizing certain revenue cycle functions, including patient access and billing. While these centralized processes are not required for joining ACOs or PCMHs, they do allow providers to have greater control over patient access and care management, as well as access to improved financial information, which is essential for competing in value-based care settings. If done well, the retooled revenue cycle can improve cost efficiencies, foster standardization across care settings and elevate the overall patient experience.
Centralizing Patient Access
When a patient accesses a healthcare organization, such as for a surgical procedure, scheduling and registration can be tedious and frustrating if the healthcare organization has decentralized processes. Multiple calls to multiple providers may be required and on each call, the patient has to provide his or her demographic, contact and payment information. Staff members receiving the information often do not share it with other aligned healthcare partners, resulting in a fragmented yet duplicative process. This not only yields a negative patient experience, it is also highly inefficient and sometimes inaccurate.
On the other hand, a centralized patient access process allows a patient to schedule and register for all necessary appointments at one time, creating a single point of contact for the patient with the healthcare organization. This streamlines the patient experience and also reduces the need for scheduling and registration staff in each area of the organization, such as the physician office, hospital, surgical department and so on. Staff members who do not become part of a condensed patient access team can be re-tasked to other revenue-generating activities.
Centralization also encourages a more standardized approach to collecting patient information and ensures that all the necessary information for both registration and billing is collected consistently from each patient. By cultivating this consistency, an organization can more accurately set the stage for the patient appointment while simultaneously limiting potential claim denials at the back end related to incorrect or insufficient patient information. Accurate claims speed reimbursement, boosting cash flow and potential revenue while decreasing the need for staff to follow up on denials.
Centralized Billing
In addition to consolidating the patient access aspect of the revenue cycle, organizations that aim to centralize billing processes can reap significant benefits as well. A key element in this effort is moving to a single patient bill.
There is nothing more frustrating for patients than receiving multiple bills for one procedure, such as when a patient has surgery and receives a separate bill from his or her physician, surgeon, radiologist, anesthesiologist and hospital. Receiving various bills for different services makes it difficult for patients to fully appreciate the true, comprehensive cost of their healthcare stay and understand how much the insurance company will cover versus how much they are responsible for paying.
Multiple bills can also give the impression that the healthcare organization is not coordinating its business operations across settings. If the patient sees that billing processes are not effectively reconciled, he or she may begin to wonder whether the ACO or PCMH is able to truly coordinate care across the continuum.
By moving to one patient bill, organizations can be more transparent about the cost of the patient encounter, lessening patient confusion and clearly communicating insurance coverage and patient responsibility. This not only enhances patient satisfaction but it also increases the likelihood the patient will pay his or her portion of the bill. When patients are clear about what they owe, they are more likely to pay.
A single bill can benefit an organization operationally as well. For example, the organization does not have to collect money from multiple invoices, but can focus on collecting for one comprehensive invoice. This reduces the number of staff needed for collection efforts and improves the efficiency of the process. In addition, administrative costs typically associated with generating multiple statements, such as printing, copying and mailing costs, will be less with a single statement approach.
It is also easier to ensure staff follows consistent processes for billing and collections when billing is centralized, improving efficiency and accuracy. This is particularly helpful if an organization is pursuing care delivery models that rely on bundled payments.
A Good Foundation for Integration
While beneficial in terms of patient satisfaction and operational efficiency, consolidating the revenue cycle can be challenging as organizations must shift from many disparate processes and departments to a more singular, standardized approach. However, the work associated with centralizing the revenue cycle is worthwhile in the long run, especially for organizations interested in pursuing integrated patient care models. Without a robust and well-tuned revenue cycle that yields consistency and efficiency across care settings, organizations may falter in their efforts to work collaboratively and fail to realize a fully integrated approach to care delivery and reimbursement.
Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation and information technology.
