approach through appropriate workforce automation tools, deploying
new payment strategies, and
reliance on analytics or business
To start, examine existing workflows and ask yourself whether they
still make sense given the changing
payments landscape. In a traditional
workflow, a patient schedules an
appointment, pays the insurance
copay, and sees a physician before
post-visit billing kicks in, a process that is still largely centered around sending periodic statements and collections.
But if patients are your top payers, this is not an effective
long-term strategy. Below is how a redesigned workflow works,
emphasizing the front end:
Pre-appointment. When a patient makes an appointment,
immediately verify insurance eligibility, run a patient-estimator
tool to review out-of-pocket costs, and collect outstanding
balances and/or estimated balances. In addition, because
patients value transparency—visibility across the end-to-end
spectrum into their explanations of benefits (EOBs), payment
expectations, payment submissions/approvals—be up front
about costs before a service is rendered. Transparency is
especially important to millennials, who are more likely than
the general population to judge healthcare organizations
by their billing practices, according to findings published by
PricewaterhouseCoopers’ (PwC’s) Health Research Institute. 5
Another key element of the pre-appointment workflow,
which is designed to help prevent no-shows and optimize
your schedule, is mobile text appointment reminders. These
reminders allow the patient to confirm an appointment, cancel, or reschedule if necessary. This simple practice can have
a big impact on your practice’s productivity, efficiency, and
Office visit. When the patient arrives, staff double-checks
eligibility and other information and obtains the patient’s cell
phone number (for text reminders) and email addresses (for
After reviewing out-of-pocket costs, collect outstanding balance and/or estimated balance.
Post-appointment. Because you complete so much of your
financial legwork up front, you have much less work on the
back end—and likely less money to collect (see “When Sending a Bill”).
Instead of spending hours cold-calling patients, the redesigned workflow relies on auto-dialer to make follow-up
phone calls to collect remaining balances, freeing up valuable
administration time. Analytics tools on the back end, too,
allow you to continually measure results of these approaches,
which is equally important, so you can adapt as this new
patient-provider dynamic continues to evolve.
As recently as five or 10 years ago,
you could easily glance at a spreadsheet and spot a problem from a
mile away (e.g., accounts receivable
[A/R] running 120 days on average).
Today, the low-hanging fruit—the
obvious, fixable problems— aren’t
there anymore. Isolating your
biggest revenue-cycle pain points
requires sophisticated tools that
can comb through data and deliver
actionable information in an easy to
understand and readily accessible format.
No single approach works the same way for every medical
group. A behavioral health practice, for example, may see a
patient who is more accustomed to paying a high copay than
an elective surgical practice, which is accustomed to seeing
other payers cover the lion’s share of a standard procedure.
Continually measure and re-evaluate your RCM activities.
Regularly communicate with your vendors, RCM consultants,
or other partners about their goals, and whether one or more
aspects of their approach could be improved.
For group practices to thrive, RCM needs to run like a well-oiled machine, sustaining the livelihood of provider groups that
depend on timely payments. The fact that patients are responsible for a huge chunk of their healthcare expenses isn’t an easy
trend to accept. Nevertheless, you need to employ proactive
tactics to ensure you’re spending less time chasing payments
and more time providing high-value, high-quality care.
Matt Seefeld is executive vice president of MedEvolve, Inc. and possesses 17 years of experience as a leading consultant in the field of
revenue cycle management.
1. TransUnion. 2017. Patients May Be the New Payers, But Two in
Three Do Not Pay Their Hospital Bills in Full. Press release, June
26, 2017. Accessed October 8, 2018 at newsroom.transunion.com/
2. Centers for Medicare & Medicaid Services. High Deductible
Health Plan (HDHP). Accessed October 8, 2018 at healthcare.gov/
3. Kaiser Family Foundation. 2017 Employer Health Benefits
Survey. Section 7, Employee Cost Sharing, Figures 7. 12.
Accessed October 8, 2018 at kff.org/report-section/
4. J.L. Dieleman, E. Squires, A.L. Bui, et al. 2017. Factors Associated
with Increases in US Health Care Spending, 1996-2013. JAMA,
318( 17): 1668–1678. Accessed October 8, 2018 at jamanetwork.
5. PricewaterhouseCoopers. 2015. Money Matters: Billing and
Payment in a New Health Economy. Accessed October 8, 2018
X Offer multiple convenient payment methods,
including online by credit card, to increase likeli-
hood of receiving payment.
X Offer to enroll patients in a payment plan if they
can’t afford to pay their balance all at once.
X Make them feel empowered about paying their