Revenue Integrity Reimagined: Building Systems That Prevent, Not Patch

Revenue Integrity Reimagined: Building Systems That Prevent, Not Patch

Access Healthcare takes the long-term view of revenue integrity—by creating operational clarity, departmental collaboration, and smarter prevention at every step of the revenue cycle.

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How Access Healthcare transformed the revenue cycle industry to become a global leader

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Hear from Anurag Jain, Chairman, Access Healthcare, as he discusses our storied history, the vision behind transforming the revenue cycle management industry, and how we’ve emerged as a global leader today.

To learn more about Access Healthcare, our proprietary technology, and our revenue cycle management services, please fill out the form below:

Access Healthcare helps clients become more efficient in the end-to-end RCM process by providing a comprehensive solution plan.

As we move through Q4, many healthcare leaders are still grappling with financial challenges. As President and Chief Growth Officer of Access Healthcare, my primary focus is supporting our clients' financial performance by making their revenue cycle processes more efficient for better financial outcomes. We provide support to hospitals and health systems along with more than half a million physicians across the country by streamlining front, middle and back-end RCM functions through the deployment of our industry-leading processes, highly experienced and well-trained workforce of more than 27,000 RCM experts and proprietary technology. The results? We boost our clients' cash collections, enhance the operating margins, enabling them to reinvest in their organizations and drive further growth.

According to a recent Healthcare Finance News article, today's CFOs are balancing the high stakes landscape of the fiscal health of their systems by managing lower reimbursements, payer denials, and rising labor costs, especially in nursing and medical tech roles. These challenges are impacting the bottom line and can affect clinical care.

One way Access Healthcare can assist healthcare organizations achieve their financial goals and deliver better care to their patients is through our AI and machine-learning based proprietary technology and analytical tools. This technology analyzes thousands of claims data simultaneously to identify both upstream and downstream processes where revenue leakage is occurring and eliminates the root causes of denials.

Our cutting-edge proprietary technology in conjunction with our highly experienced workforce helps our providers better connect with patients, manage their charts more accurately, which leads to faster collections.

Recently, we helped one of our Northeast-based health system clients collect more than $10 million in additional cash flow from previously denied claims by deploying our echosmrt analytics tool to identify the wrongly denied claims and then using our smart AI-based automated workflow system to accurately follow and appeal those claims. By identifying the root causes of denials, we developed and deployed customized denials prevention strategy for this health system and reduced denials by 29 percent. This brought the AR days down by seven days and increased the net collection rate by 3.5 percent while it also reduced the cost to collect by 35 percent.

Access Healthcare helps clients become more efficient in the end-to-end RCM process by providing a comprehensive solution plan rooted in our award-winning technology and our team’s expertise. This allows our clients to provide top-notch care to their patients and further support healthcare providers in numerous communities across the nation.

All my best,
Kumar Shwetabh, President, and Chief Growth Officer for Access Healthcare

About Access Healthcare

Access Healthcare stands as one of India's largest and fastest-growing providers of healthcare business processes and technology solutions. Our team of over 27,000 professionals operates from 20 service delivery centers across three countries, emphasizing global delivery, workflow optimization, and our award-winning AI-enabled technology platform.

Since 2011, Access Healthcare has been a trusted partner to the US healthcare sector, leveraging domain expertise, technology, automation, and analytics to enhance clinical outcomes, financial performance, and operations for healthcare providers and payers.

To learn more about how we ensure information security and compliance in healthcare business process services delivery, please fill out the form below:

Access Healthcare recognized among Best Organizations in Innovation at ET Now Global Innovation Network 2024

ET Edge recognized Access Healthcare as one of the Best Organizations in Innovation 2024 at the prestigious ET Now Global Innovation Network 2024 summit held in Mumbai on June 26, 2024. Mahesh Ramakrishnan, Senior Vice President - Application Development, Satheesh Seetharaman, Vice President – Innovation and Shaju Subramanian, Senior Director & Site Head - Access Healthcare Mumbai represented the company at the event and accepted the trophy.

ET Edge is an initiative of The Economic Times to build global business intelligence through engaging forums that focus on key sectors and domains. Every year, such events recognize the outstanding achievements of India's most innovative companies and their contributions to driving economic growth, social progress, and global competitiveness.

Access Healthcare's culture of innovation and the transformative impact on our clients in the healthcare industry were key factors in securing this prestigious recognition. We have revolutionized the healthcare revenue cycle landscape by leveraging advanced technologies and data-driven insights to build one of the world's largest offshore revenue cycle management companies. Our commitment to utilizing cutting-edge technologies such as artificial intelligence and automation has resulted in streamlined processes, improved efficiency, and enhanced financial performance for healthcare providers.

About Access Healthcare

Access Healthcare stands as one of India's largest and fastest-growing providers of healthcare business processes and technology solutions. Our team of over 27,000 professionals operates from 20 service delivery centers across three countries, emphasizing global delivery, workflow optimization, and our award-winning AI-enabled technology platform.

Since 2011, Access Healthcare has been a trusted partner to the US healthcare sector, leveraging domain expertise, technology, automation, and analytics to enhance clinical outcomes, financial performance, and operations for healthcare providers and payers.

To learn more about how we ensure information security and compliance in healthcare business process services delivery, please fill out the form below:

Patient Access Tech Transforming Healthcare Revenue Cycle

A COMPREHENSIVE APPROACH TO ENHANCING PATIENT EXPERIENCE

Patient experience has become crucial for success in the evolving US healthcare landscape. With the rise of healthcare consumerism, patients now demand more control, convenience, and transparency in their care. This article explores the importance of improving patient access and provides a comprehensive approach to enhancing the patient’s experience.

The Current State of Patient Access

Patient access, the gateway to healthcare services, currently faces several challenges:

  • Fragmented Care Pathways: Disjointed care processes often lead to patient dissatisfaction due to a lack of continuity in care. A recent survey revealed that 73% of patients found their healthcare journey fragmented and confusing (Source: HealthLeaders Media, 2023).

  • Inefficient Scheduling Systems: Outdated scheduling methods result in long wait times and appointment mismatches. On average, patients wait 26 days to schedule a physician appointment in 15 major US cities, according to the 2023 Survey of Physician Appointment Wait Times by WSHA.

  • Lack of Transparency: Patients are frequently unaware of treatment options and associated costs, leading to unexpected expenses and dissatisfaction. A 2024 McKinsey report suggests that with proper incentives and information, patients would be inclined to shop for healthcare services, potentially affecting 20 to 25 percent of US healthcare claims spend. This shift could unlock significant gains in affordability for consumers.

The Need for Transformation

The US healthcare sector is undergoing a paradigm shift:

  • Evolving Patient Expectations: Modern patients expect seamless digital experiences similar to those in banking or e-commerce. Currently, 80% of patients prefer digital solutions, including telehealth options.

  • Operational Efficiency: Implementing a streamlined patient access system can optimize resource utilization and lower operational costs. Institutions that have adopted such systems report a 30% reduction in operational expenses.

  • Competitive Differentiation: In a crowded market, prioritizing patient experience can set institutions apart from competitors. According to a Patient Engagement HIT study, 73% of patients indicated they would switch providers for a more consumer-friendly experience.

A Comprehensive Approach to Enhancing Patient Experience

To meet and exceed these evolving expectations, a multifaceted approach is essential:

  • Centralized Scheduling: Implementing a unified scheduling system can simplify the appointment booking process, allowing patients to manage their schedules more efficiently. Institutions that have adopted centralized scheduling report a 50% reduction in no-show rates, according to an MGMA article titled "Implementing Central Scheduling to Support Practice Growth and Success in the Accountable Care Environment."

  • Digital Front Door: Providing a one-stop digital portal empowers patients to access healthcare information, communicate with providers, and manage their health journey. An Accenture study found that 68% of patients are more likely to choose a provider that offers digital tools for managing their health.

  • Transparent Pricing: Clear pricing structures enable patients to make informed decisions about their care. An estimated 59% of patients seek pricing information before receiving care, and 40% compare prices between providers.

Transformation in Patient Access Call Centers

Patient access call centers have traditionally served as the initial point of contact for many patients. However, as the healthcare landscape evolves, the role and operations of these call centers are also transforming. This shift is driven by the need to enhance patient experience, streamline operations, and integrate with the broader digital healthcare ecosystem.

  • From Reactive to Proactive: Traditional call centers were primarily reactive, responding to patient queries as they arose. Modern call centers, however, take a proactive approach by reaching out to patients for appointment reminders, follow-ups, and health check-ins, thereby ensuring continuity of care.

  • Integration of Advanced Technologies: AI-driven chatbots, predictive analytics, and CRM systems have become integral components of call centers. These technologies help efficiently handle routine queries, predict patient needs, and personalize interactions.

  • Omni-channel Support: Beyond traditional voice calls, call centers now offer support via email, chat, video calls, and even social media. This multi-channel approach ensures that patients can interact with healthcare providers on platforms they are most comfortable with.

  • Data-Driven Insights: Modern call centers leverage data analytics to gain insights into patient behavior, preferences, and feedback. This data-driven approach allows for continuous improvement in service quality and patient experience.

  • Enhanced Training and Skill Development: The role of a call center representative has evolved from merely scheduling appointments to offering comprehensive patient support. This evolution necessitates regular training sessions to ensure representatives are well-versed in the latest healthcare protocols, communication skills, and technology tools.

  • Security and Compliance: With the increasing amount of patient data being handled, call centers are investing heavily in ensuring data security and compliance with regulations like HIPAA. This ensures that patient data is protected, and trust is maintained.

  • Collaboration with Healthcare Teams: Call centers are no longer isolated units. They now collaborate closely with healthcare professionals to ensure that patient queries related to treatments, medications, and health concerns are addressed promptly and accurately.

  • Focus on Patient Experience: The goal of these transformations is to enhance patient experience. From reducing wait times to ensuring personalized interactions, every change is geared towards making the patient's journey smoother and more satisfactory.

Implementing the Transformation

Transforming Healthcare Patient Access: A Comprehensive Journey

The transformation journey in healthcare, particularly in patient access, is complex and multifaceted. It requires a strategic approach built on a clear vision and unwavering commitment. Here are the key pillars of this transformative journey:

  • Stakeholder Engagement: Engaging all stakeholders, from clinicians to administrative staff, is crucial for the success of the transformation process. Their involvement ensures a comprehensive approach to change and fosters collaboration.

  • Technology Investments: Investing in modern technology platforms is essential to support and enhance patient experience transformations. The US healthcare IT market is projected to reach USD 270.3 billion by 2021, highlighting the importance of technological advancement.

  • Training and Development: Ensuring that staff have the necessary skills and understanding to navigate and champion new processes is vital. Continuous training and development programs help staff adapt to changes and maintain high standards of care.

  • This strategic approach to transforming patient access in healthcare focuses on engaging stakeholders, investing in technology, and prioritizing training and development to achieve a seamless and efficient healthcare experience.

Measuring Success

Ensuring Effective Transformation: Monitoring and Metrics

Regular monitoring is essential to ensure the transformation is progressing as planned. Here are key metrics to track:

  • Patient Satisfaction Scores: These scores provide insights into how patients perceive the changes. Patient-reported experience is associated with higher future revenue and lower costs of hospitals. Eur J Health Econ (2023).

  • Operational Metrics: Metrics such as wait times and no-show rates offer a snapshot of operational efficiency, helping to identify areas for improvement.

  • Financial Outcomes: Improved patient access can enhance patient retention, leading to greater financial success. Enhanced access typically translates to increased patient volume and revenue.

By regularly tracking these metrics, healthcare organizations can ensure their transformation efforts are on the right track and making a positive impact.

The Future of Patient Access

As technology continues to advance and patient needs evolve, patient access will undergo significant transformations. The integration of technology with a personal touch will be crucial, and comprehensive engagement partners will play an indispensable role in fostering growth.

  • Cultural Shift Towards Patient Experience: Transforming patient access involves more than just implementing new technologies or processes; it requires a cultural shift towards prioritizing the patient’s experience. By adopting a comprehensive approach, healthcare institutions can meet and exceed patient expectations, leading to enhanced satisfaction, operational efficiency, and financial success.

Healthcare institutions that embrace this holistic approach will be better positioned to adapt to changing patient needs and technological advancements, ensuring long-term success and improved patient outcomes.

About Access Healthcare

Access Healthcare stands as one of India's largest and fastest-growing providers of healthcare business processes and technology solutions. Our team of over 27,000 professionals operates from 20 service delivery centers across three countries, emphasizing global delivery, workflow optimization, and our award-winning AI-enabled technology platform.

Since 2011, Access Healthcare has been a trusted partner to the US healthcare sector, leveraging domain expertise, technology, automation, and analytics to enhance clinical outcomes, financial performance, and operations for healthcare providers and payers.

To learn more about how we ensure information security and compliance in healthcare business process services delivery, please fill out the form below:

Outsourcing Ambulatory Revenue Cycle Management

ENHANCING FINANCIAL SUCCESS IN PHYSICIAN PRACTICES AND MEDICAL GROUPS

Effective revenue cycle management (RCM) is vital for the financial well-being of ambulatory care clinics. However, evolving authorization requirements and reduced allowable charges have complicated RCM. This article examines how outsourcing RCM services can assist ambulatory clinics in overcoming these challenges and achieving financial success.

CHALLENGES IN AMBULATORY RCM

Ambulatory clinics encounter distinct challenges in their revenue cycles. Recent shifts in payer dynamics have led to more prior authorization requirements, increased denials, and reduced payment allowances. The growing number of CMS patients has further decreased overall reimbursement. Additionally, higher premiums and deductibles have increased accounts sent to collections, forcing clinics to allocate more staff to a claims cycle process that yields less revenue. This results in higher workload on staff and pressure on collections. With high attrition and overworked staff, clinics are struggling to meet their financial goals.

IMPACT OF CHANGING AUTHORIZATION REQUIREMENTS AND LOWER ALLOWABLE CHARGES

The impact of changing authorization requirements and lower allowable charges has significantly affected provider organizations recently. Increased prior authorization requirements from payers have led to more denials and complications in the claims process, resulting in payment delays and decreased overall revenue for providers.

Additionally, reduced payment allowances from payers have intensified the financial challenges faced by provider organizations. Lower reimbursement rates have further strained clinics, compelling them to find ways to maintain financial stability while ensuring quality patient care.

Moreover, the increasing number of patients covered under CMS (Centers for Medicare and Medicaid Services) plans, which typically offer lower reimbursement rates than other payers, has contributed to reduced revenue for provider organizations.

Consequently, these dynamics have forced provider organizations to allocate more staffing resources to manage the complex claims cycle process while receiving diminished payments.

THE VALUE OF OUTSOURCING

Many ambulatory clinics are now outsourcing RCM services to effectively tackle these challenges. By relying on industry experts for their revenue cycles, clinics can ease the burden of managing complex authorization requirements, denials, and payment issues. This approach provides access to specialized expertise and resources that enhance the revenue cycle, allowing internal staff to concentrate on patient care and core operations. Access Healthcare is a partner of choice for several clinics helping them navigate the complex revenue cycle management and receive payments with agreed timelines.

BENEFITS OF OUTSOURCING RCM

Outsourced RCM services offer numerous advantages for ambulatory clinics. Primarily, they ensure accessibility and transparency in their relationships. Clinics appreciate the swift resolution of issues, consistent service representatives, and the accountability provided by their RCM service partners. Collaborating with an outsourced firm allows clinics to achieve immediate revenue boosts, gain valuable education, implement best practices, and develop long-term strategies to enhance their revenue cycle workflows. Access Healthcare serves as an extended arm to clinics and partners with them to manage their Front-end, Mid-Cycle, Back-end processes efficiently and accurately.

MEASURING EFFECTIVENESS AND ROI of outsourcing

Clinics assess the effectiveness of outsourced RCM services using various metrics. Key performance indicators, including A/R days, clean claims rate, denials, and total collections, help evaluate the performance and impact of these services. By utilizing data analytics and reporting capabilities, clinics can monitor and optimize their revenue cycles, ensuring a positive return on investment. Access Healthcare works with Clinics and has clear dashboards to showcase results and have periodical reviews with the organization to measure effectiveness and deliver outcomes.

OVERCOMING WORKFORCE CHALLENGES WITH OUTSOURCING

Ambulatory clinics frequently face workforce challenges such as recruitment, retention, and budget constraints. Outsourcing RCM services can help address these issues by offering access to a specialized team with expertise in ambulatory care billing and coding. Utilizing the resources of the outsourced firm, clinics can optimize staffing levels, maximize labor budgets, and reduce the burden of workforce management. Access Healthcare has over 27,000 resources who work with several clinics and ensure a quick ramp up when the need arises to take on additional responsibility of the clinics.

CHOOSING THE RIGHT OUTSOURCING PARTNER

When contemplating outsourcing RCM services, ambulatory clinics must select the right partner. Providers should look for firms that comprehend the complexities of ambulatory care, including local regulations and specialty-specific requirements. Key considerations in choosing an outsourcing partner include open communication channels, proactive reporting, and a proven commitment to the clinic’s success. Access Healthcare has the necessary subject matter experts (SME) for several specialties who are trained and certified. We also have worked with most medical billing systems for efficient integrations to kick-start the operations on-time.

Conclusion

In today's complex healthcare landscape, ambulatory clinics face numerous challenges in managing their revenue cycles. However, outsourcing RCM services can help clinics overcome these obstacles and achieve financial success. Outsourcing provides accessibility, expertise, and specialized resources that enhance revenue cycle efficiency. By measuring performance, optimizing staffing, and choosing the right outsourcing partner, ambulatory clinics can streamline their revenue cycles and focus on delivering quality patient care.

About Access Healthcare

Access Healthcare stands as one of India's largest and fastest-growing providers of healthcare business processes and technology solutions. Our team of over 27,000 professionals operates from 20 service delivery centers across three countries, emphasizing global delivery, workflow optimization, and our award-winning AI-enabled technology platform.

Since 2011, Access Healthcare has been a trusted partner to the US healthcare sector, leveraging domain expertise, technology, automation, and analytics to enhance clinical outcomes, financial performance, and operations for healthcare providers and payers.

Outsource your revenue cycle management to experienced experts and achieve financial success while focusing on providing exceptional patient care. Please fill out the form below: