Better Healthcare Through a Better Hospital Revenue Cycle

By: Oscar Gonzalez Click author's name for more of his/her articles

The Healthcare debate continues to unfold. But at least there is one point of agreement: The current US Healthcare system is perceived as being very inefficient.

If you have ever received treatment at a hospital in the US you have probably been exposed to some of the admin complexity that this entails. Such are the innefficiencies in the administration processes that according to the American Hospital Association sixty percent of hospitals lose money providing patient care.

To be precise, Healthcare Providers lose $60bn per year because of administrative errors. To put this into perspective this equates to the 2007 cost of providing universal healthcare through the National Health Service to 25 million people in the United Kingdom.

Problems begin right at the registration point. It always amazes me just how much information must be gathered and processed at patient registration time; information such as insurance plan code, insurance eligibility, demographics, credit risk, charity availability, deductible amount and much more. Patient registration not only involves the creation of the patient's medical record, which must be accurate in order to provide appropriate treatment and care, but, in addition, a healthcare provider's ability to collect payments directly correlates to an efficient and accurate registration process.

An innovative approach to improving the registration process is to enable hospitals to not only access the information needed, but to customize the information to fit the required process, and then intelligently and automatically guide the patient-facing employees to use the information effectively through on-screen interactive guides.

To understand what I mean by the patient-facing employees being ''intelligently guided'', let's examine one of the many registration processes that are key to the hospital's overall revenue cycle: the insurance verification process. When a registrar has gathered enough information for the insurance verification process to be carried out, a message is sent to the appropriate data source to validate that the patient does have that particular insurance plan and it is in force at that point. The system then validates the terms of the plan and what the copay amounts are. During the registration, it sends that information back to the registrar, who would be automatically prompted to use that information, and then be guided to the next set of relevant questions.

With other methods, the information received from the different sources is not readily available in an easy-to-use format. The registrar has to interpret the information and glean whatever information is relevant. On the other hand, with a system like the one described here, the data is automatically interpreted and the appropriate set of prompts is shown to the registrar to seamlessly continue to the next step in the registration process.

An additional requirement for such a system is that it seamlessly integrates with a healthcare provider's existing patient registration system, thus allowing the hospital to have a patient registration system that determines who is going to pay for the treatment and in what shares it is going to be paid - part insurance, part Medicare, part Medicaid or part co-pay or if it is the growing number of people who are self-paid or self-insured. And when there are multiple insurance companies, the claim needs to be submitted in the right order.

Systems like this can vastly improve the hospital's revenue cycle. Better processes which are error-free, less costs, a drastic reduction of losses and ultimately more money available to be spent where it really matters: delivering a better service to the community.

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About The Author: Oscar Gonzalez is the Marketing Manager for the Cincom Intelligent Business Applications group. For over 10 years he has helped develop solutions for customers in the financial services and healthcare markets both in Europe and the USA . Oscar is a member of the Chartered Institute of Marketing, NAHAM and HFMA. He can be reached on on his cell (UK) 07976722197 or via email at ogonzalez@cincom.com or visit