by Helen Williams, Senior Healthcare Consultant, Azalea Health
Last updated 8/29/2019
For years, the healthcare industry, driven by CMS and payer requirements, has been focused on capturing as much clinical patient data at the time of care as possible. Now, we are seeing a rise in high deductible health plans (HDHP) where patients are more financially responsible for their health expenses.
And with the rise in patient responsibility comes a decrease in patient collection rates, an increasingly large source of hospital revenue. With that in mind, collecting patient financial information is just as critical to hospital operations as collecting a patient’s clinical data is to their overall health and recovery.
According to the State of the Industry: Top Trends for Rural Health Providers in 2019 report, declining reimbursements are the number one challenge for rural healthcare facilities. When looking at ways to improve the revenue cycle and maximize reimbursements, hospitals need to look at the entire process, not just the back office. This starts as early as the patient registration process.
Patient Registration Overview
The process of registering a patient is, seemingly, self explanatory. It is the need to capture the patient’s demographics, insurance information, and health history in order to provide patient care.
However, it is actually more complicated than a “check the box” process. There are many nuances that go into patient registration in hospitals that are outside of the clinical purview. Fundamentally, the patient registration process is not only the beginning of patient care at the hospital, it is also the beginning of the revenue cycle for the facility.
Beware of the Quick Reg
The “quick reg” (sometimes referred to as “quick admit”) feature offered by many hospital EHR vendors is a necessary evil.
Commonly used in the Emergency Department (ED). this feature allows for minimal patient information to be captured before the patient is seen. There are circumstances where this workflow is necessary. For example, a car accident patient is brought in alone and unconscious by ambulance.
Quick reg works well in this scenario as the patient is in a dire situation and can’t share necessary clinical and financial information. The patient is processed immediately and the intake/registration process does not prevent them from receiving critical medical care.
However, in too many cases, we see the quick reg used outside of these circumstances. For instance, at night when the registration clerk has gone home but the ED is still open. Or perhaps even during the day when staff are busy and need to get patients seen quickly.
So why should we be cautious of the quick reg?
It’s quite simple. Patient registration is the beginning of the revenue cycle for a hospital.
The information captured during this process is critical to hospital financials, yet is often a victim to short cuts and incomplete fields. Without that information, the hospital cannot be paid.
Our studies show that the ED, the heaviest users of quick reg, is a significant source of hospital bad debt. While not the full answer to bad debt, capturing all of the patient’s financial information in the beginning is critical to improving hospital financials.
Don’t let the inefficiencies of one area of your workflow negatively impact other areas downstream. To help reduce the number of errors or lack of data captured during the quick reg workflow, we recommend your facility establish thoroughly documented patient intake processes so that all staff members can appropriately admit patients. In the instances where quick reg is necessary, make sure your system has built in prompts or work queues for staff to easily track records that need to be updated at a more appropriate time.
Improving Registration Leads to Better Hospital Financials
Improving hospital workflows is not always easy. However, there are some simple fixes you can implement. Here are three workflows your facility can quickly build into your patient registration processes. In doing these more frequently, you are one step closer to improving revenue collection and transparency.
- Insurance Verification
Insurance verification is a simple way to determine a patient’s insurance coverage for their visit to the hospital. Most EHR vendors have this workflow built into their system without needing to go to another website. Despite this simplicity, this step is frequently skipped for various reasons including not enough time, lack of proper training, and simply assuming that known-repeat patients have had no changes since the last visit.
By adding insurance checks into your registration process, you can identify upfront what coverage the patient has. This empowers your hospital to begin the financial conversation with the patient and inform them earlier in the process about any expenses they may need to cover outside of insurance.
- Patient Responsibility Estimates
No one likes surprise bills, especially ailing patients. And the rise of high deductible health plans is only compounding the surprise bill problem. And if a patient receives a surprise bill, their likelihood of calling the facility to challenge it is likely, if they even address it at all. Additionally, a TransUnion Healthcare study noted that “the persistent trend of rising patient financial responsibility after insurance exacerbated the growth in uncompensated care…Patients facing higher deductibles and co-pays were not always paying their providers for medical services rendered.”
While not a critical component of the registration process, utilizing patient responsibility estimates provides transparency to the patient for what they will owe after a given procedure. By providing this financial transparency up front to the patient, they are more likely to work with your facility on payment options because they will be more prepared, both mentally and fiscally.
Start simple by using patient estimations for pre-scheduled procedures and stays. Eliminating surprise bills will help bring in more patient revenue to your facility.
- Dedicated Registration Clerk 24 Hours a Day, 7 Days a Week
Who is the resource checking in patients that come into the ED at 2:00 AM?
Is it a registration clerk who is trained on hospital intake processes or is it a new nurse who is working the night shift? All too often in Critical Access Hospitals, we see a clinical staff member doing patient registration after hours. These staff members are not well-versed or trained in the registration process. They went to school to take care of sick patients and help them get better.
Frequently, these late-night admits will typically be done through quick reg and sufficient financial information isn’t captured.
If your facility operates on a tight budget and can’t afford an around the clock patient registration team, here are a couple of suggested workflows:
- Train all night staff on the hospital’s patient registration process.
- Conduct utilization reviews each morning for patients that came in overnight to ensure all necessary information was captured.
Patient Registration and the Patient Experience
One of the first experiences a patient has with your facility is during the registration process.
Chances are when they come in your doors, they are overwhelmed/scared/nervous and ailing. In this fragile state, they are handed a clipboard with multiple pages of questions, hospital policies, and HIPAA verbiage. None of which are written in layman’s terms that make it easy to understand. This compounds the emotional situation and can make for the start of a poor patient experience.
In rural communities, a poor patient experience can be detrimental to the long term success of the facility. Word of a bad experience from a single patient can spread like wildfire and result in lack of referrals.
Patient registration is a great time to build a personal connection with the patient. Taking the time to explain the registration process, hospital policies, visiting hours, and how to use the hospital’s phone are just a few things that can be done early in the registration process to ease the patient’s worries. And, in the event of financial questions, having trained staff members available to talk to patients can help alleviate financial strains and allow the patient to focus on their care.
If you are interested in learning how you can improve operational efficiencies and your bottom line, please reach out to us and schedule a conversation. Our team of rural health experts are here to help.