Tribhuwan works in Database Administration where he leads a group of database professionals.
Solomon’s career development is building with each new day at HealthWare Systems. Tribhuwan says his, “dream of leading a team of database experts and providing sound database background processes to different applications was fulfilled at HealthWare Systems. The company offered me a way to learn different platforms and provided resources for my success.”
Tribhuwan says that at HealthWare Systems, “the voice of any person can be heard effectively without repercussions. An employee could walk up to the owner of the company to discuss things and they are open to it. Human Relations is more of a friend than a machine for onboarding. The budget is flexible, and the company is open to buying resources that help employees.”
Solomon is helping the company reimagine the patient experience by living out his passion. Tribhuwan is passionate about, “making a difference in the lives of patients,” and had been even before starting at HealthWare Systems. He knew he was perfect for the job.
Solomon has worked on many projects throughout the years at HealthWare Systems. One project he highlights is the Patient Encounter System, also known as Facilitator. “Facilitator has been my favorite project,” says Tribhuwan.
Facilitator is a platform that streamlines pre-arrival workflow, prior authorization, medical necessity checking, insurance verification, appeals management, financial assistance screening, release of information, and more.
“I was very new when this project started and learned how hands-on the owner of the company was. It was very comforting to see my boss being there for me during the entire process. The structures and logistics which were designed for this project are still working reliably across different hospital systems and collection agencies,” Tribhuwan shares.
It’s employees like Solomon who allow HealthWare Systems to live up to such words as trustworthy, simplicity, and agility.
Thank you, Solomon, for sharing your experience and being a valued member of the HealthWare Team! We look forward to your continued success and accomplishments.
Patient Payment Estimation Requirements Under the No Surprises Act
Posted on Saturday, December 4, 2021
Does your facility have the proper tools to meet the patient payment estimation requirements under the No Surprises Act?
In 2022, the No Surprises Act will require providers or facilities to inquire about patients’ insurance status when scheduling and “provide a good faith estimate of expected charges for items and services” to uninsured/self-pay patients. Uninsured/self-pay patients are those who do not have benefits for an item/service under a health plan or who choose not to have a claim submitted to their plan for the item/service.1
Additionally: “The good faith estimate must include expected charges for the items or services that are reasonably expected to be provided together with the primary item or service, including items or services that may be provided by other providers and facilities.”1
Are You Prepared?
Under the No Surprises Act, if any of your uninsured or self-pay patients is billed for an amount “substantially in excess” (defined as $400 or more) of the good faith estimate you provided to them, they may use a new “patient-provider dispute resolution process” (within 120 days of receipt of the bill) to determine a payment amount.1
The process allows them to request a third-party arbitrator to review the good faith estimate, the bill, and information submitted by you, the provider or facility, to determine whether the excess charges are allowed.2
Are you prepared for the No Surprises Act and the new patient payment estimation requirements?
Limit the occurrences of this scenario by implementing the right patient payment estimation solution.
Patient Payment Estimation with Facilitator
HealthWare Systems’ revenue cycle platform, Facilitator, includes a patient payment estimation tool that identifies the potential out-of-pocket costs a patient may incur. And not only can Facilitator help you prepare for the No Surprises Act’s patient payment estimation requirements, but it can also improve your revenue cycle in 2022 by streamlining:
Business process automation (BPA) is the digital transformation of organizational workflows. BPA utilizes technology to automate manual, repetitive, routine tasks and to streamline processes. BPA applies business logic to respond to events, make information “actionable,” and anticipate next steps to proactively manage workflow.
Benefits of Business Process Automation
Business process automation enables organizations to assign their valuable time and employees’ skill sets to other objectives while technology takes care of the monotonous, time-consuming, and routine operations for them.
In addition to time, BPA saves organizations money. It is a cost-effective way to increase efficiency and speed up workflow. Plus, digital transformation of business procedures reduces paper usage (making processes more budget and environmentally friendly).
By limiting the opportunity for human error, BPA also improves accuracy and prevents deficiencies.
Facilitator can apply BPA to the following areas that affect the healthcare revenue cycle:
Facilitator is a BPA platform built specifically for healthcare.
Pre-Arrival– prevents integrity issues that can result in technical denials or underpayments.
Prior Authorization – automates authorization requests using 278 transactions, web-crawling, fax requests, and payer portals; automatically checks status of pending authorizations; monitors status changes that affect patients’ authorized benefits.
Insurance Verification – verifies insurance in real time; identifies potential restrictions that may impact reimbursement; finds any unreported coverage by searching top regional payers.
Medical Necessity Checking – verifies medical necessity in real time; shares results with referring physician; produces ABN for patient signature; provides automated updates of LCD and NCD rules.
Financial Assistance Screening – determines the likelihood that patients will qualify for financial assistance; manages documentation requirements and selects/completes application forms based on eligibility program(s) pursued.
Appeals Management – routes denial work object to appropriate team member for resolution; generates appeal letter or form specific to payer or denial type; assembles appeals package and submits appeal; eliminates hard copies.
Release of Information – securely captures, gathers, and sends medical records; eliminates hard copies.
Electronic Medical Forms – business rules determine the correct forms needed for every patient’s specific encounter, so employees no longer need to memorize selection criteria; pre-populates forms with patient demographics.
Business process automation is increasingly necessary for the success of today’s organizations, including those in the healthcare field. Through BPA, hospitals and health systems can streamline workflow while lowering costs, better allocating resources, and increasing accuracy.
Increase Patient Collections Through Patient Financial Education
Posted on Monday, February 3, 2020
Addressing patient financial education needs can help you increase patient collections. When patients understand their medical bills, health insurance, and patient responsibility, they are much more likely to make their payments.
The following solutions by HealthWare Systems can help you improve patients’ understanding of their financial responsibility and increase patient collections:
ActiveASSIST is our financial assistance and self-pay management solution. ActiveASSIST is a patient advocacy tool that aids staff in providing compassionate and supportive financial counseling to patients.
Increase patient collections by providing patient financial education.
ActiveASSIST identifies alternative funding sources (e.g. government programs, charitable initiatives) for patients. Many patients are unaware of the various financial assistance options available, or that they may qualify. Our patient-first technology finds potential matches for them, manages the application process, and monitors documentation requirements, deadlines, and follow-up tasks.
By educating patients about their financial assistance eligibility and helping them secure funding, ActiveASSIST can leave patients with a smaller, more manageable portion of their bill to pay (or their costs may be completely covered by financial assistance).
As our all-in-one revenue cycle platform, Facilitator can streamline your financial assistance workflow as well.
Additionally, Facilitator generates patient estimates and determines patients’ potential out-of-pocket costs. Patients want price transparency. If patients know what costs to expect up front, they will feel better informed. They are less inclined to be upset when they receive their bill and more apt to pay it.
With Facilitator, you can also review prior balances across multiple sites, collect payments, or set up payment plans to help patients understand and resolve their financial responsibility.
February is National Wise Health Care Consumer Month. This month we are reminded of the importance of empowering and educating patients so that they can make wise health care decisions, including wise financial decisions related to their health.
This is an opportune time to implement revenue cycle solutions that will improve patient financial education and, as a result, increase patient collections.
ActiveDEFENDER monitors the entire patient encounter to prevent errors that lead to reimbursement denials, delays, and underpayments. (Read here how ActiveDEFENDERreduced bad debt by 50% at Bon Secours Charity Health System.)
Resolution – Improve Collections
Facilitator can simplify collections with one-click access to a consolidated view of patient responsibility that includes prior balances (across multiple sites), out-of-pocket costs for the current visit, and qualifying discounts.
ActiveASSIST can help you better manage your self-pay population and ensure that you as the provider are “payer of last resort” by exhausting all other funding options for patients first (e.g. government-funded programs and charitable sources).
Resolution – Increase Patient Satisfaction
All ActiveWARE products create improvements that increase patient satisfaction. But one factor that especially affects patient satisfaction is patient wait times. ActiveTRACK is proven to increase patient satisfaction by reducing both registration and clinical patient wait times. In fact, ActiveTRACK reduced patient wait times by 75% at an acute care facility in the Chicago Suburbs.
There are many cost benefits of electronic healthcare forms as well. With ActiveFORMS, there is no need to pre-print and store forms or waste money destroying old pre-printed versions that can no longer be used due to new updates. Instead, forms are instantly and electronically delivered wherever a patient presents and can be printed on-demand if a physical copy is necessary. And if not, you can go paperless with electronic signature.
Resolution – Perform a Health Plan Audit
An annual health plan audit can help you maintain compliance with payor contracts and ensure your front desk staff are prepared to collect the appropriate co-pay or deductible from each patient. If you’re not already, resolve to conduct a health plan audit at least every year.
Have you set New Year’s resolutions for your revenue cycle?
What are your New Year’s resolutions for your revenue cycle? Chances are, one or more of our ActiveWARE products can help. Contact us today to learn more… and have a Happy New Year!
91% –The percentage of physicians who say the prior authorization process postpones patients’ access to necessary care.
28% –The percentage of physicians who say the prior authorization process has resulted in a serious adverse event for their patients (e.g., “death, hospitalization, disability/permanent bodily damage, or other life-threatening event”).
86% –The percentage of physicians who describe prior authorization burdens as high or extremely high.
Almost 2 Business Days (14.9 hours) –The average length of physician/staff time that is devoted to prior authorization requirements per physician per week.
36% –The percentage of physicians who have employees who work solely on prior authorization tasks.
Clearly, health systems face many challenges related to preauthorization. Patient safety is compromised when care is delayed. Patient and physician satisfaction are at risk as patients endure frustrating waits for treatment and physicians deal with administrative duties that disengage them from their medical work.
And not only can each prior authorization be costly, but excess costs are also incurred in the forms of extra clerical staff and rework when prior authorizations are denied and must be resubmitted.
According to CAQH CORE, 88 percent of prior authorizations are completed either partially or completely manually; and, the majority of preauthorization issues are related to manual processes.
Appealing to Millennial patients can help your facility keep up on the latest healthcare trends.
Appealing to Millennial patients is becoming increasingly important to a healthcare facility’s revenue cycle. Not only do they number 83.1 million and make up over 25 percent of the U.S. population, but Millennials are also driving new healthcare trends.
“We found that Millennials tend to want to have access to care right away, they want it immediately and they want to be able to see a doctor quickly . . . When they feel well, they don’t want to go to the doctors, and they don’t. So then when they feel unwell, they’re like I want to see a doctor right away and not wait for weeks for an appointment.”
Unfortunately, this trend has serious consequences. While many Millennials are health-conscious, they may be missing out on recommended eye exams, blood pressure screenings, PAP smears, STD/STI screenings, mental health screenings, and IBS/digestive exams, as well as failing to get vaccinations on time.
In order to help ensure Millennials receive the care they need, heed the healthcare trends that are appealing to Millennial patients. The following are a few ideas to help get you started:
Don’t Waste Their Time
Wait times – As noted, Millennials don’t want to wait for care. The following common scenario is definitely not appealing to Millennial patients: first waiting days or weeks for an appointment, then waiting 20-30 minutes in the waiting room, THEN waiting in the exam room even longer before the doctor actually shows up. To prevent this situation from occurring, implement a solution like ActiveTRACK, which can lower wait times by 75%.
Telehealth – Offering telemedicine appointments is another way to help Millennial patients save time, something they highly value. Millennials are technologically savvy and accustomed to immediacy and convenience, so telehealth options may be attractive to them.
Simplify the Financial Aspects of Healthcare
Payment plans – One factor that may be keeping Millennials from accessing healthcare is the high cost. Offering payment plan options so that they don’t have to cover the cost of a large bill all at once can help Millennial patients afford the care they need.
Price transparency – Millennial patients want to compare costs between providers and obtain out-of-pocket estimates before receiving care. They also want to understand their bills before they pay them.
Health insurance confusion – Many Millennials are confused about their health benefit options and medical bills. Clearing up their health insurance confusion can really help you stand out from your competition. An easy place to start is by educating patients that many plans cover annual physicals at no cost.
Stay Technologically Relevant
Online payment options – Millennials are more likely than older generations to pay their bills using technology or mobile devices and may see paper bills as inconvenient and outdated.
Interoperability – It is hard for a generation that grew up with constant technological progress to understand how healthcare has been unable to keep up. In other aspects of Millennials’ lives, data can be instantaneously transferred with a click of a button. Interoperability in healthcare will be expected too, and there is technology that can help you achieve it.
In other industries, Millennials are used to having many choices. They expect companies to offer convenience and respect their time, provide competitive and transparent pricing, and keep pace with changes in technology. Health systems can learn from these consumer-centered practices that are standard in other markets. Plus, these practices are becoming more attractive to other generations as well.
Appealing to Millennial patients will help your facility keep up on the latest healthcare trends, attract a large group of potential patients, and boost your revenue cycle.
4 Ways to Build a Culture of Patient Advocacy at Your Facility
Posted on Wednesday, February 6, 2019
How can a healthcare facility practice patient advocacy? Of course, patient advocates offer wonderful support to patients. But providers can create a larger culture of patient advocacy at their facility as well by tackling a few key areas.
Here are 4 ways hospitals can support their patients and build a culture of patient advocacy:
1.) Address The Social Determinants of Health
Create a culture of patient advocacy with Patient-First Technology like ActiveASSIST.
Supporting your patients’ social needs is an incredible form of patient advocacy. It can also lead to better health outcomes and lower healthcare costs for your facility.
2.) Offer Financial Assistance Screening
A lot of patients don’t realize that financial assistance may be available to them. Many hospitals have changed their financial assistance policies to include not only the uninsured, but the underinsured as well.
Notifying patients of which programs they could qualify for demonstrates a great deal of patient advocacy. What really goes above and beyond, though, is facilitating the entire financial assistance process on behalf of your patients!
By exhausting all other payment options first, you also ensure the provider is payer of last resort.
3.) Alleviate Stressors Surrounding Costs and Payment
Larger-than-expected or difficult-to-decipher medical bills, as well as health insurance confusion, are major sources of frustration for patients. They can also result in unpaid medical bills and medical debt, or cause patients to forgo some health services altogether.
Reducing patient uncertainty concerning the financial aspects of their care would help you foster a culture of patient advocacy. Ensuring patients are financially cleared before arrival, generating estimates and identifying potential out-of-pocket costs, and setting up payment plans are all ways you can assist patients in this area.
What a perfect time to share educational materials and classes related to health insurance and financial assistance with your patients. Perhaps the best way to advocate for your patients is to help them develop the skills they need to advocate for themselves!
Each of these areas provides you with excellent opportunities for patient advocacy. Plus, there is a bonus: supporting any of these endeavors can ultimately improve your bottom line as well.
Practicing patient advocacy will help you support your patients, improve the patient experience, and offers financial benefits for all parties involved. Developing a culture of patient advocacy can truly pay dividends.
The Social Determinants of Health & Their Effect on Health Outcomes
Posted on Friday, August 17, 2018
The social determinants of health are increasingly on the radar of health professionals and health systems. The National Academy of Medicine (formerly the Institute of Medicine) even recommends this information be included in patients’ medical records.
Hospitals can utilize screening tools to collect patient data concerning the social determinants of health. While a provider may not be able to resolve all social issues faced by a patient, identifying them can help inform healthcare decisions. (Providers should also have a list of resources that attend to social needs available to provide the patient when asked.)
When health systems consider the social determinants of health when caring for their patients, all parties benefit. Patients have better health outcomes, communities improve, and health systems become advocates for their patients (improving patient satisfaction) while saving money. The social determinants of health not only impact the health of patients, but also the health of a hospital’s revenue cycle.
Social factors that influence patients’ health & healthcare decisions include:
Employment – A good job can provide a patient and his/her whole family with health benefits and insurance. Unemployment negatively affects physical and mental health.
Income – A steady paycheck allows a patient to pay for many of the other factors in this list, such as adequate housing, nutrition, and transportation, as well as healthcare costs. (Financial assistance screening tools can help patients find out if they qualify for charitable programs to help offset the cost of care, and enable hospitals to facilitate the application process for their patients.)
Housing – Poor living conditions increase the risk of infectious disease, injury, chronic illness, pest and mold problems, and indoor air pollution. And each year, 1.48 million Americans have no home at all. (Here are some examples of how hospitals can help meet patient housing needs.)
Violence – The area in which patients live also can affect their exposure to violence or abuse. Victims or witnesses to acts of violence may experience mental, physical, and/or economic consequences that affect their overall health.
Nutrition – A lack of consistent access to healthy food can negatively impact health outcomes and increase the risk of many adverse health conditions. Over 12.7 percent of U.S. households were affected by food insecurity in 2015. (Read our previous blog for more information on how to reduce patient malnutrition.)
Transportation – Access to reliable transportation can govern a patient’s access to medical care. Approximately 3.6 million Americans miss or postpone medical care due to transportation issues. (Check out these ideas for addressing patient transportation needs.)
Social Support – As reported by NPR, in a recent nationwide survey conducted by Cigna “nearly 50 percent of respondents” said “that they feel alone or left out always or sometimes.” Two in five respondents “felt like ‘they lack companionship,’ that their ‘relationships aren’t meaningful’ and that they ‘are isolated from others.’” Patients who feel unsupported are more vulnerable to poor health outcomes. (Read how physician empathy can generate better health outcomes.)
Language/Culture – Culture influences our beliefs about health and healthcare. A patient’s ability to communicate with health professionals may be impeded by language barriers.
Education –According to the CDC, people with higher levels of education are more likely to choose healthy behaviors and refrain from unhealthy ones. People with lower levels of education are more likely to be obese and more likely to smoke.
Sex/Gender – Many health conditions affect men and women differently and certain treatments may be more or less effective depending on the sex of the patient. Plus, men are less likely than women to see a doctor for a specific health concern, preventive healthcare, or a standard annual exam. (Consider these tips for improving male patient engagement.)
The social determinants of health are key to improving health outcomes and the revenue cycle.
It’s not difficult to imagine how the above factors might influence one another. The social determinants of health are interconnected and work together to impact a person’s health and healthcare decisions.
Patients whose social needs are unfulfilled are more likely to utilize healthcare resources at a higher cost (including the Emergency Department), be readmitted, miss appointments, and have poor health outcomes.
Reducing patient uncertainty should be a high priority item for healthcare providers. Feelings of uncertainty can affect the patient experience and lower patient satisfaction.
Most of us are uncomfortable with uncertainty and many visits to healthcare facilities are made with the purpose of diminishing it. Patients seek out your facility hoping to find answers to health questions; the last thing they are looking for is even more confusion.
Reducing patient uncertainty can vastly improve the patient experience.
Below are 6 areas that can either increase or decrease patient uncertainty.
By reducing patient uncertainty through addressing these areas, providers can greatly improve the patient experience:
For example, a study published in the journal Health Communication found that video biographies for primary care physicians were more effective in reducing patient uncertainty than the standard text biographies that most providers post on their websites.
2. – Wayfinding:
Navigating their way around an unfamiliar building can increase patients’ anxiety over their hospital visit. Wayfinding solutions (such as digital signage, mobile apps that guide patients around your campus, and touchscreen kiosks that print wayfinding maps) can ensure that patients and their visitors don’t get lost, all while reducing patient uncertainty about finding their destination.
3. – The Waiting Room:
The waiting room offers numerous opportunities for reducing patient uncertainty surrounding many topics. In the waiting room, uncertainty about wait times can be just as frustrating as the actual waiting. Patients’ family members face uncertainty as well, about how long they’ll be waiting, about the details of a procedure, and about the outcome for their family member.
Patients should not have to face uncertainty regarding whether their doctor has all the information he/she needs to properly care for them. Yet, only 46% of hospitals had required patient information from outside providers or sources available electronically at the point of care according to research posted by the Office of the National Coordinator for Health Information Technology.
Researchers have created a new tool called the Uncertainty Scale to measure patient uncertainty and predict hospital readmissions. Some of the major themes they’ve found in their work include patients’:
“Lack of clarity regarding self-management, such that patients are unsure how to deal with symptoms at home”
“Lack of self-efficacy, manifesting as patients not knowing where to go for help for certain symptoms”
“Lack of clarity about the decision to seek care, meaning that patients do not know which symptoms are serious enough to warrant seeing a health professional”
Uncertainty is unfortunately a common experience in healthcare for those with undiagnosed conditions and symptoms for which an explanation is unclear. The six areas outlined here are within your control; by reducing patient uncertainty in these areas, your facility can greatly improve the patient experience.