Solutions

Solutions powered by SVG logo for hStream platform.
Learn More.
Frame 586 (1)

Quality Manager formerly known as abaqis®

Mitigate risk and elevate your quality of care. Improving both clinical and business outcomes starts with a smarter, more integrated approach to regulatory training, continuing education and quality management.

Learn More

NEW TO THE STORE

hStream Content Marketplace

Connecting you to the Best Content. Access to 75 Partners and 35,000+ Courses in our Industry-Leading Marketplace. Streamline content purchasing, updates, hosting, and connectivity for your organizational needs

NurseGrid Learn

Online store for Clinical Learners. Individual CE Credit and industry products for Clinical Learners are now available through NurseGrid Learn (Beta). Explore our robust collection of courses that provides an unparalleled level of flexibility and choice.

Practitioner Courses

Meet the DEA's new requirement under the Medication Access and Training Expansion (MATE) Act in an online, high-quality and self-paced 8-hour DEA MATE Act course specifically designed for practitioners, including Physicians, PAs, NPs, Pharmacists, Dentists and others.

LATEST & POPULAR

BLOG

CredentialStream named the top credentialing software by G2
REPORT

2024 Annual Report on Medical Staff Credentialing
On-Demand Webinar

State of the Industry: What’s Next for Healthcare Quality & Safety in 2024?
BLOG

Summer 2024's Top Choice in Healthcare Credentialing: CredentialStream
BLOG

HealthStream Executive Briefing: CMS Minimum Staffing Standards: What You Need to Know
Webinar

Clinical Placement for the Future of Healthcare: myClinicalExchange Discussion with CommonSpirit Mt Region and UW Health

< HealthStream Resources

blog

24-WD-Q&C-598-Patient Access Blog Activation (Step 2) 02. Blog Image-V1-MD

Improving Patient Access Can Help Maximize Your Revenue Cycle

November 4th, 2024
November 4th, 2024

A critical step to managing your revenue cycle effectively is mitigating the challenges related to patient access, which has a profound impact on claims and denials.

Healthcare providers feel enormous pressure to optimize their revenue cycles, particularly in today’s environment where operating margins are tighter than they were before the pandemic. In this post, we will outline some of the obstacles that patients face when trying to access care. We will also discuss strategies that providers can use to help improve patient access and that can lead to revenue cycle optimization.

Challenges Impacting Patient Access

Despite advancements in technology and administrative practices, patient access continues to be a challenge. Patients encounter multiple barriers when accessing care, including:


  • Technical hurdles
  • Lack of transportation
  • Insufficient insurance coverage
  • Healthcare staffing shortages
  • Education and language barriers
  • Affordability
  • Prior authorization hurdles

However, it’s not just about getting patients through the doors. Healthcare providers need to prioritize having streamlined processes that minimize financial or other setbacks for patients when they attempt to get care.

A well-designed patient access system considers the entire process from scheduling and registration to appointment management, patient billing, and patient communications. If the system functions poorly, it can reduce patient access and lead to lost revenue, which can accumulate because of denied claims, rework, and appeals.


Common Issues Leading to Claim Denials

Understanding the causes of denied medical insurance claims is one tactic to address the issue of patient access. There is a wide range of reasons that claims are denied in healthcare, and we describe a few key ones below:


  • Missing or inaccurate data: Ensuring all data is accurate and complete before submission is essential. Automation tools and EHR systems can help reduce human error during data entry.
  • Authorizations: Pre-authorization requirements can vary greatly between different payers, so it’s important for providers to verify authorization needs promptly to avoid denials.
  • Inaccurate/incomplete patient information: Comprehensive intake processes and regular staff training can mitigate issues related to incomplete or incorrect patient information.

As described below, there are other issues beyond denied claims that can hinder the revenue cycle for providers.


  • Frequent changes to payer policies – Recent surveys highlight an unsettling trend --77% of healthcare professionals report that payer policy changes are happening more frequently, up from 67% in 2022. These changes complicate the claims process, requiring constant vigilance and adaptation by healthcare providers. The frequent policy shifts mean that staying informed is no longer optional; it’s imperative for maintaining a seamless workflow and ensuring that claims are processed efficiently.
  • Increasing reimbursement delays – The time it takes to be reimbursed is also on the rise, with 67% of healthcare professionals indicating an increase in 2024, compared to 51% in 2022. This growing delay in reimbursements can place a strain on healthcare organizations, impacting cash flow and financial planning. These delays not only affect the financial health of a practice but also its ability to invest in better technology or hire additional staff and those are crucial aspects of improving patient access and care quality.
  • Surge in claims errors and denials – In a September 2024 survey by Experian Health, 55% of providers said errors in claims submissions are increasing, which is an increase from 43% in 2022. This uptick correlates with a higher rate of claim denials. The survey revealed that 38% of respondents said claims are denied 10% of the time or more, while 11% reported denial rates exceeding 15%. The high denial rates underscore the need for more robust data management and verification processes within patient access departments.

Strategies to Reduce Claim Denials

One approach to improving your revenue cycle is to find ways to reduce claim denials. Here are some steps to take to achieve that:


  • Stay organized – Keeping track of denied claims using tools and technology will help improve the process. Monitor trends with your denials by recording details such as the doctor, department, payer, and procedure.
  • Move swiftly – Create a validated process to get denials resolved within a reasonable timeframe. This is easier to accomplish when you have an effective and efficient workflow.
  • Build a task force – Have a dedicated team to help analyze and prioritize denial trends. This group can track your progress and help you determine the resources needed to resolve denials.
  • Leverage predictive analytics – Using artificial intelligence to analyze historical claims data can help identify potential denial patterns.

Patient access is a key element in the revenue cycle. By prioritizing improvements in this area, healthcare organizations can reduce the incidence of claim denials and have a more efficient and financially stable practice.

Learn more about how HealthStream can help you optimize your revenue cycle.

Request Demo