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1. With patients now flocking to provider offices after some patients delay care, front and back office provider staff would be overwhelmed. Mixing manual and electronic processes was difficult before COVID-19. Could you please talk about this struggle and how it could affect the hiring and retention of employees?
A. As the country emerges from the COVID-19 pandemic, provider offices are inundated with patients who have not received routine and non-urgent care. Provider schedules are now double and triple booked with patients, and the volume overwhelms staff. In addition, some administrative staff are used to working from home and may seek employment that allows them to continue working remotely.
These factors, along with increased responsibilities, skills and training requirements, can make it difficult to find a good practice administrator. Compensation must align with the increased expectations of this role to retain employees. According to the United States Bureau of Labor Statistics, employment prospects for healthcare administrators are expected to increase by 32% by 2030. With increasing pressures and increased demand, provider practices will need to retain this talent. or face a competitive landscape to replace these employees. .
2. What are the main areas of the income cycle where administrative help might need help? Preliminary authorisation? Refusal of complaints?
A. The three key areas where healthcare administrators experience the greatest frustration are claim attachments, denial management, and pre-authorization. Attachments to claims are a point of contention for administrative staff, as health plans have different requirements. To alleviate this burden, providers should integrate a revenue cycle solution that includes an all-payer option for consistent processes across all contracted health plans.
Refusal management is a second area in which healthcare administrators could benefit from technological solutions. A recent analysis by the Kaiser Family Foundation indicated that claim denials were 17% in 2019, up from 14% in 2018. Provider practices spend a lot of time working on denials after a claim is processed. Electronic solutions allow administrative staff to move the process of changing accounts and claims upstream, improving administrative workflows and reducing accounts receivable days.
A final and possibly the biggest area to help provider administration is in pre-authorization. Staff report spending a lot of time and resources determining whether or not a health plan requires prior authorization. Studies show that this can help delay patient care and increase administrative costs. Adopting electronic solutions can ensure a smoother process to help patients get quality care in a timely manner.
3. How has COVID-19 affected the way work is done? Are more workers now working remotely from their homes, and should this continue? What do you see as the future of the non-clinical hospital workforce?
A. When COVID-19 was declared a pandemic in March 2020, office staff went from office to working at home almost overnight, and staff went from calling or faxing payers to have to learn new electronic systems. . The pandemic has propelled the adoption of technology and has shown once resistant healthcare workers how they can work more efficiently. While some front desk staff will need to return to the brick and mortar office, other functions may more easily move to home offices. In the future, we will likely see a mix of administrative staff in the office and at home.
4. What technology is available and how can it help?
A. Many revenue cycle companies and clearing houses exist to help ease the burden on healthcare administrators by improving efficiency. Most vendor firms now have an EHR and a system that automates complaints and billing functionality, but office staff do much more than billing.
For example, front office staff use technologies that verify eligibility, provide communications with patients, schedule appointments, and accept payments from patients. In the back, staff use technology to process claims, manage denials, manage payor contracts, and process health plan payments and remittances.
Revenue Cycle Solutions consolidate pre-service to post-service and post-award processes into a single workflow.
– Lillian Phelps is Senior Director of Product Management at Availity, a revenue cycle solutions company.
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