The traditional role of banks in RCM (revenue cycle management)
Banks have traditionally played a critical role in serving the healthcare industry. They are payment aggregators, digital and paper lockboxes, data normalizers, systems of record, and more. They are the unsung heroes of healthcare—the trusted, sturdy gears that make an incredibly complex revenue cycle turn.
But they’re also an old institution. No one is looking to them for creative solutions to new problems. Yet, they have the experience and the means to make waves. They also know the rules—so they know how to break the rules…and where and when. They aren’t built with the agile phalanx of technical resources required to burrow into the complex networks of legacy systems that comprise providers’ most-used IT tools.
Yet, providers have a thirst for this kind of creativity. Patients are frustrated, hospital debt is soaring to record levels, and reimbursement rates are decreasing. So, health systems are looking for a more consumer-oriented model. To meet that need, we will see banks performing a duet with innovative technology companies to produce solutions that work for payers, providers, and patients: Think Tony Bennett, partnering with fresh voices like Amy Winehouse and Lady Gaga for a new twist on the old classic to satisfy a modern audience.
Playing matchmaker: Opposites attract
Banks know their stake in the game. After all, they provide healthcare with financial backing. If hospitals are not financially healthy, banks suffer as well. Yet, banks do not necessarily have the ability or desire to reach patients directly.
At the same time, a record number of technology vendors are amping up their healthcare game. For 7 years, innovators have been rushing to connect all healthcare stakeholders, sparked by the HITECH Act of 2009, followed quickly by Meaningful Use in 2012. This proliferation, however, requires risk and it means that some innovations will succeed while others will fail. Competition is fierce, funding is limited, integration is hard, and government regulation introduces a quagmire that challenges even the most nimble and brilliant tech stars.
Yet, payers, providers, and patients need a system they can trust, that links the silos through the administrative arc of the patient experience: patient access, revenue cycle, and onsite experience.
These challenges give way to the marriage of healthcare’s odd couple. Innovative tech companies can rely on the strengths of banking’s time-tested institutional experience and infrastructure for moving money through complex systems and navigating regulatory environments. Meanwhile, banks can expand their reach to improve the patient experience through nimble, risk-taking, forward-thinking technology vendors.
Connecting systems and people to make change
Banks and IT vendors will partner to create the tools for a consumer-driven healthcare system. Here are 8 ways that innovative, consumer-driven features will enhance billing and collections for healthcare.
1. Connected IT Ecosystem. Web services are critical in pulling backend data from a variety of hospital source systems into one single interface. Patients can access their administrative tasks from any device, including onsite kiosks. Staff can easily manage patient scheduling, flow, and billing at the point of service from a robust web-accessible dashboard. No more repetitive manual data entry—on either side of the registration desk!
2. Access to actionable information on any device. Increasing transparency and convenience online and at the point of service with a modern, digital twist increases patient satisfaction scores by 5%. It also improves the bottom line. Because patient demographic information tends to be wrong over 30% of the time, the simple act of ensuring patient information on file is correct can reduce bad debt by over 4%. In addition, eliminating paperwork improves patient satisfaction and staff morale by offloading the most tedious part of their job. In fact, one national multi-facility healthcare system has increased staff efficiency by 15%.
3. Online appointment request. This is the age of OpenTable and Apple Genius Bar reservations. Patients want to find appointment times that suit their schedules without having to spend time on hold and tediously comparing calendars. Now they can click a button and receive a confirmation that their preferred time is available. As an added bonus, each appointment booked online saves healthcare systems $7.00 per interaction.
4. Insurance verification. Healthcare systems can get ahead of the billing cycle by asking patients to review and update their information before they even arrive on site. Verifying that the right insurance is on file increases billing clean claim rate by 22%. By the time they arrive for their appointment, patients have a clear understanding of whether the service is covered in whole, in part, or not at all—in addition to what the co-pay is and the amount of the deductible. This transparency will shift healthcare billing to a more consumer friendly experience.
5. Eligibility. Eligibility gives patients and staff the necessary benefits coverage information for an upcoming service. By presenting patients with this information before service, they can talk to their providers about their options and make better decisions about their course of treatment. Determining eligibility can also help healthcare organizations reduce claims denials and put the proper safeguards in place to ensure patients have the support structure they need. For example, a healthcare organization might provide financial assistance or payment plans for patients who cannot afford service. After all, caring for a patient’s financial health is part caring for a patient’s overall wellbeing.
6. Payment estimates. Estimates are commonplace in the service sector and almost completely lacking in healthcare. However, banks and innovative healthcare IT vendors will partner to pull forward patient responsibility. Patients will be grateful for the opportunity to pay their share up front since they won’t have to think about settling up after service. This creates an enormous opportunity to get ahead of accounts receivables and to advance the consumerism trend.
7. Payment options. Most patients are eager to have online access to lab results, account information, costs of common procedures. They also want a consolidated bill and a system that makes it easy for them to pay (i.e., a wide range of payment options that includes secondary insurance, credit cards, HSA, and/or a payment plan). With payment options at patients’ fingertips, paying bills will be that much easier. In fact, by presenting patients with outstanding bills at the point of service, this increases the chances of collecting payment by 62%. For the consumer, this approach removes the transaction cost of having to think about finding the credit card or writing the check and moves more quickly off a patient’s to-do list. For healthcare systems, these simple enhancements shorten collections cycle over 90 days by 18%.
8. Onsite queuing. Not only does staff have a consolidated view of patient information, billing, flags, and alerts, but they also have the ability to prioritize patients in their waiting room from the same dashboard. Staff can sort by wait times—or appointment type—to ensure that no patient is left sitting too long. Giving staff the tools to monitor patient flow onsite reduces wait times from 10 to 2 minutes.
Staying on the top through Innovation
Tony Bennett first appeared on stage in 1946—70 years ago. Now, at 90 years old, Bennett’s collaboration with Lady Gaga earned a Grammy and sold over 1 million copies worldwide. A legend in his own right, Bennett says he isn’t done learning. He’s looking at future collaborations, perhaps with Beyoncé. His willingness to step out of his comfort zone and innovate with other artists who can offer a fresh perspective is what gives Bennet his edge even in the modern era.
Banks first revolutionized healthcare over 25 years ago by introducing services that shuttled money and information accurately and on time. It’s time for them to step back into the spotlight. Like Bennett, banks are a classic. They have the power to leverage both their experience in consumer sector and expertise as the backend glue in healthcare to simplify administrative tasks for staff and consumers alike.
To enact real change, banks will look to partner with the innovative risk-taking vendors to connect with the users. Banks and IT vendors are the power couple that will develop powerful new solutions for healthcare’s newest challenges.
Reducing friction in the revenue cycle and improving the consumer experience? Well, that’s music to our ears.