Financial clearance, patient advocacy, and the effects of the pandemic on revenue cycle management

Welcome to Perspectives, brought to you by Physician’s Practice. I'm Drew Boxler, Editor of Physician’s Practice.

Every two weeks, we will be exploring key areas of a successful, thriving, independent practice. We’ll hear from experts in the industry regarding best practices for billing and collections, answer your top coding questions, analyze current legal trends, malpractice landmines to avoid, and look at the hottest tech innovations to increase productivity and enhance the patient experience.

Let’s get started…

Physician’s Practice®: Today, I am pleased to feature our discussion with Dan Dooley, Vice President of physician services at R1, a leading provider of technology-enabled revenue cycle management.

Earlier this year, as the pandemic was fully setting in, we spoke with Dan about how revenue cycle management likely change as a result of the pandemic.

Here’s what Dan had to say.

Dan Dooley: In many ways, the pandemic has exacerbated trends that existed in the market previously. Costs have been increasing, revenues have been decreasing for some time. And so the need to more efficiently collect the revenues that are owed to our practice is, you know, something that has obviously escalated in importance here in the near term, changes in terms of digital front door strategies, allowing patients to self-serve many of the scheduling and registration requirements, and the financial clearance process is something that is increased in importance here recently. And the third being, you know, changes in the actual delivery of clinical care. And how revenue cycle supports that variation, whether it be you know, telehealth services with virtual visits, or just phone calls.

In many ways, the pandemic has exacerbated trends that existed in the market previously. Costs have been increasing, revenues have been decreasing for some time. And so the need to more efficiently collect the revenues that are owed to our practice is, you know, something that has obviously escalated in importance here in the near term, changes in terms of digital front door strategies, allowing patients to self-serve many of the scheduling and registration requirements, and the financial clearance process is something that is increased in importance here recently. And the third being, you know, changes in the actual delivery of clinical care. And how revenue cycle supports that variation, whether it be you know, telehealth services with virtual visits, or just phone calls

Physician’s Practice®: One of the trending alliterations at the time of our discussion was that of the ‘new normal’. 

For physician practices and revenue cycle management, Dan said that there were three aspects to anticipate in this ‘new normal’ word.

Dan Dooley: I'd say, first and foremost, it's looking for opportunities to variable eyes, your expense structure, you know, your fixed costs, you know, and a couple areas to look at there are your vendor contracts, ensuring that the payment terms within those contracts are aligned to your volumes and your revenues. So that as those decrease, your expenses decrease correspondingly with that.

The second is really looking at opportunities to implement and or improve some of those digital front door strategies. It has a dual benefit of really meeting the consumer where they're at today, they expect to have those types of capabilities available to them. And the second benefit is it reduces any unnecessary exposure between patients and staff.

I'd say the the third area is really leveraging the financial clearance processes to be laser focused on the uninsured population. You know, obviously, over the course of the last couple months, there's been a significant growth in the unemployed. And those unemployed, people are going to require additional help to be able to secure the funding that they need to get the services that they need. And again, it has a dual benefit of improving practice profitability, but probably most importantly, patients that have insurance are more apt to seek and receive the care that they need.

Physician’s Practice®: Of course, the main topic of our discussion was going to be financial clearance. Up next, Dan defines ‘financial clearance,’ and what that means, specifically, for R1.

Dan Dooley: Well, there's multiple definitions in the market. At R1, we define the processes beginning immediately after the point of scheduling all the way through the point of receipt of clinical care. Within that, we're really looking to execute against three core parts of the process. The first being securing accurate information from the patient, both from the demographic’s perspective, coverage perspective. The second, then, is securing all the required forms for HIPAA consensus, etc. And I'd say the third and, you know, I'd argue, you know, maybe the most important right now is ensuring that patients are educated as to their coverage, their benefits, and what to expect in terms of out of pocket expense. And leveraging that process to ensure every patient is triaged into a financial risk profile so that high-risk patients that need more help in terms of actually securing funding for their services are, are helped and treated accordingly. And patients that are low risk, you're basically leveraging time that you create from triage and those patients appropriately a focus on the high-risk patients.

Physician’s Practice®: To establish that financial clearance, Dan says that there are about four critical building blocks physicians need to meet.

Dan Dooley: Well, I'd say there's four. The first is ensuring that you have a strong point of view on what best practices are through that process. We define that as a set of methods that start from scheduling and go through the time of service, we break it into four key components: scheduling and orders, the pre-service financial clearance process, financial advocacy for those patients that need extra help. And the fourth being, you know, the check in process, you know, commonly referred to as registration throughout that it's an ensuring that the staff is adequately trained on all of those best practice points through the process. The second is making sure that you have technology that enables those processes, giving the staff the tools that they need to be more efficient and to adhere to those processes.

And I'd say three and four are probably the most important. It's having metrics that measure that process all the way through, both from an in-process perspective (are you getting coverage verification 100% of the time, to the outcome metrics in terms of what's happening with your denial rates? how effectively Are you collecting patient out of pocket, etc.) and an accountability structure that allows you to see daily basis, monthly basis, weekly basis, quarterly basis? Educate your staff help your staff to be more successful?

Physician’s Practice®: To optimize your financial clearance process, Dan says that you should follow the following specific steps.

Dan Dooley: Well, I'd say first and foremost, it's getting the basics right on the uninsured population. So, 100% of the time making sure that you are adhering to those best practice points and executing against that process, so that you're optimizing the collections that you're getting from the patients that do have insurance.

After that, it's being able to triage that patient population effectively to understand which ones are at higher risk for not being able to pay. So that starts with screening, all of your own insured patient should be screened to identify which funding sources they may qualify for. After you've identified some potential funding sources, it's providing them with the help that they need to actually move through the process of securing that funding. So, some patients are able to do that more effectively than others. And so again, if that triage mechanism allows you to ensure that you're kind of holding their hand through what can be a very challenging process with federal government guidelines, state government guidelines, and community programs that are available.

Physician’s Practice®: One way to improve financial clearance is to utilize new technology. For example, Dan says that automation is a good technology to use. 

Up next, hear how this technology can benefit your financial clearance process.

Dan Dooley: Well, automation has the dual benefit of increasing efficiency and increasing adherence to the process. You know, so some examples of automation, you know, are to 70 to 71, coverage, verification, automation, automation around ensuring that authorizations have been secured, and that the payer recognizes those.

All of those are sort of basic process steps that free up time and allow you to focus on those patients that have the need for sort of greater follow up or more complex treatment in the financial clearance process. Getting more advanced on automation, you're able to then start to initiate processes where patients can self-serve smart questionnaire forms that help guide them to specific funding sources that maybe available to them, and really starting to hardwire processes that allow you to ensure that you're hitting all of your metrics effectively

Physician’s Practice®: As you are streamlining your financial clearance processes, you will need to look out for particular KPIs or performance metrics. Dan says that the following are the most important for physicians to pay attention to.

Dan Dooley: Well, at R1, we have roughly 39 metrics that we apply to those points in the financial clearance process I was describing.

I'd say it in terms of those metrics, there's probably two ways to answer that question. One, it's really key that you have an in-process metrics and outcome metrics. So it's about having the metrics you need to be able to monitor the staffs execution against the process as designed, and then monitor the outcomes of that process so that you can identify defects that lead to continuing improvements and collection rates.

Some examples of that would be from an in-process metrics perspective: it's your authorization complete rate, your coverage verification rate, “what rate did I educate my patients that were coming in in terms of their benefits?”, you know, copay, ask rate, etc. From an outcome metric perspective, it's going to be things such as denials, denial rates, collection, yield against patient out of pocket, etc.

Physician’s Practice®: Finally, Dan offered some specific goals that practices should be aiming to reach. 

Dan Dooley: The goals are going to vary based on a practice’s unique situation, so it's really more about the journey of improvement than the specific goal, as it relates to outcome metrics. On the in-process metrics, it's about executing those 100% of the time. And so you do that by, you know, having an analytic layer that allows you to monitor that on a daily basis, provide feedback in real time to your office staff or t o yours support staff in to in relationship to the performance, identify improvement opportunities, etc. And so that's, that's really the key.

Physician's Practice®:

Once again, thank you Dan.

And thank you all for listening to this eighth episode of Perspectives, brought to you by Physician’s Practice.

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