John Donnelly (JD) is the CEO and founder of FrontRunnerHC, a SaaS solutions provider at the forefront of providing ground-breaking technologies to meet dynamic health care revenue cycle management (RCM) requirements. With decades of experience in the health care technology and insurance billing industry, JD founded FrontRunnerHC in 2010. The company’s solution portfolio leverages a real-time software platform and claim-agnostic database to support hospitals, labs, physician groups, and other health care organizations.
Revenue cycle management in today’s environment is tough. Providers are getting squeezed with decreasing reimbursements and increasing expenses, leading to shrinking margins that impact success. With pressure from both sides—as well as the pressure of consumerism—it’s critical that providers get paid for the services they deliver while also ensuring their patients’ financial experiences are as positive as their clinical experiences. The reason it’s so critical is because, as we often say, the Patient Experience = Clinical Journey + Financial Journey™. But ensuring that the patient’s financial journey is a positive one is easier said than done when you consider all that’s involved.
While the patient’s financial journey will vary depending on the type of organization, one thing is constant: from the moment a patient is registered to the time the claim is paid, there are challenges that jeopardize both the provider’s ability to get reimbursed and their patient’s experience.
For many of our lab clients, as an example, the high-level steps that might impact their patient’s financial journey are listed below, along with a primary goal we help them achieve at each step:
- Patient registration: Capture accurate patient information.
- Specimen collection: Provide smooth process for onsite or at-home testing.
- Cadence management: Ensure everyone is accounted for during testing.
- Test results: Communicate test results via SMS or email.
- Compliance: Verify patient’s test results for entry to flights, events, work, etc.
- Claims process: Expedite claim submission to patient, payer, or government.
- Payment: Expedite payment collection and understand patient’s propensity to pay.
So, what can go wrong along the patient’s financial journey? This article isn’t long enough to go into all possible problems, but you can get a glimpse of them in the following graphic:
The conversations we have with clinical labs and other health care organizations about their patients’ financial journeys are always interesting. Most health care leaders we speak to find themselves nodding in agreement as we talk about this journey and the challenges en route.
What is the root of these issues?
The root of many of the issues is bad data: missing, incomplete, or inaccurate patient demographic, insurance, or financial information.
For starters, one common problem occurs when the patient’s insurance changes from the time they’re registered and have their lab test, so the insurance information in the system is invalid. With more people changing jobs these days, the more insurance plans are changing as well. This means that when collecting the specimen, your lab or sales staff must often manually call the clinician’s office to track down the correct information—something that neither your staff nor the clinician enjoys.
Suffice it to say, the patient’s financial journey can get pretty bumpy. And those bumps are felt by many: the patient, the referring physician, and your organization.
So, what’s the solution?
The news isn’t all bleak. By leveraging data automation technology, providers can quickly tackle these problems or better still, prevent many of them from happening in the first place. They can capitalize on opportunities to manage their costs, address volume fluctuations, and get paid faster while enhancing the patient experience.
At last year’s Executive War College conference, I had the pleasure of presenting with our client, Nichole Kerr, director of revenue services at Sonora Quest, on this important topic. Sonora Quest is a great example of an organization who is leveraging data automation, and we’re honored to collaborate with them.
During the presentation, Nichole referenced the 2020 CAQH Index, which reported that automation had resulted in efficiency savings of $122 billion for the US health care system in 2020. And yet, as she also pointed out, an estimated one in four providers still aren’t leveraging data automation in their revenue cycle workflow.
Nichole shared her team’s experience and some of the results Sonora Quest has attributed to implementing data automation, such as:
- Days sales outstanding (DSO): decreased by 10–13 days
- Cash collection: more stable with 103.7 percent collected vs goal
- Increased capacity to prioritize and resolve “at risk” unbillable accounts receivable (AR)
- Write-offs due to claims being too old to bill declined by 7 percent, saving $1 million
- Outgoing missing information letters: decreased by 12–13 percent annually
- Outgoing service and postage costs: decreased by 13 percent annually
- Improvements in patient satisfaction measures:
- Abandoned calls decreased by 65 percent
- Call service factor improved by 28 percent
- Patient call volumes decreased by 19 percent
Ensure your lab’s long-term sustainability and growth
Quickly collecting reimbursement for the services you’ve provided while maintaining a positive patient experience has never been a higher priority. Data automation can be leveraged anywhere in your patient’s financial journey—whether at the front-end or back-end—wherever it makes the most sense in your process. In today’s environment, data automation can not only help your clinical lab survive but it can also ensure your long-term sustainability and growth.