High deductible plans and complex payer networks have put an increased strain on clinical operations, revenue cycle workflows, and the patient experience at a growing radiology practice in the Pacific Northwest. With an average volume of over 200 patients a day, staff simply cannot keep up with manual processes related to checking benefits and providing cost estimates to patients.
Patients get frustrated not knowing the cost of service beforehand, and the practice has found it challenging to quickly and accurately provide this information. This makes it difficult to collect patient fees up front, leading to a back-end-weighted revenue cycle that is complicated and lengthy.
“High deductible plans and complex payer network shave put an increased strain on clinical operations, revenue cycle workflows, and the patient experience”
- The practice's Business Office Director
Staff did not have a process in place for up-front benefits verification and had to rely directly on patients to understand complicated insurance plans. This led to a lot of errors with prior authorizations, collecting payment from patients, denials, and delayed reimbursements. They needed a solution to automatically detect key benefits information from patients prior to service so they could provide price transparency to patients and improve their collections. “We knew where the problem was, but we needed a system to catch it on the front-end which had never been implemented here,” said the Patient Accounts Manager.
“We knew where the problem was but we needed a system to catch it on the front-end”
With a heavy patient volume, and no process in place to accurately collect payment at the point of service, the practice knew they had patient experience and collections issues to resolve but struggled to find a solution. Patients were unsure of their financial responsibilities prior to service, leading to angry calls from confused patients after the fact. “I would go in and give someone a cost estimate if they asked for one, but it was a lengthy, manual process,” said the Patient Accounts Manager. “It’s not something I could do for every patient.” This often caused a delay in payments increasing the practices days outstanding.
“Other companies work off of past claim data and not actual contracts, so they just gave us a ballpark, but that’s not what we wanted. We wanted something that was extremely accurate and really MD Clarity was the only software we found [with that level of accuracy].”
- The practice's Patient Accounts Manager
The practice began searching for a solution that could provide extremely accurate estimates to patients prior to procedures. The practice quickly found that MD Clarity’s software was the only one that met the practice's exacting specifications.
- Today, each patient is provided an accurate estimate of their financial responsibility before a procedure is performed. Armed with MD Clarity’s proprietary pricing engine, the practice’s insurance specialists are able to automatically determine allowed amounts in real time, accounting for CMS and payer rules, facility structure, and complex adjustments.
- The Clarity Flow module has been implemented to capture key patient benefit information on the front-end, allowing the practice to find errors that could lead to delayed reimbursement or denials before they happen.
- MD Clarity’s workflow by exception was implemented, which automates the majority of the verification process and only flags patients with insurance issues for staff follow-up. Today, over 85% of patient’s verifications are automated.
- The combination of MD Clarity’s pricing engine, ClarityFlow module, and reporting features gives managers access to the data they need to make better decisions for the practice, and ensure the practice gets paid faster.
The implementation of MD Clarity’s solutions has been a huge success. Patients love having a clear picture of their financial responsibility. Staff enjoy the increased automation, reducing their manual tasks by 85%. The practice has seen a dramatic reduction in bad debt and an increase in patient collections.
“From day one, it went much easier than staff anticipated,” said the Patient Accounts Manager “Patients really appreciated knowing what they owed before going into the service”
- The practice's Patient Accounts Manager
The practice began searching for a solution that could provide extremely accurate estimates to patients, prior to their procedures. Ultimately MD Clarity’s solution best met their needs.