Improved access to patient benefits and a consultative approach made a positive impact on denial rates and collections.
For a large health system in the southwestern United States, retrieving complete benefits information was a significant challenge. When running a Standard 30 query, the results were missing detailed benefits for PT/OT, inpatient, MRI/CT, ambulatory surgery, and more. Trying to test multiple queries led to the system overwriting the prior response. This forced the team to go to websites to obtain the missing information, then manually enter it into the system so an accurate estimate could be created. Consequently, the team faced the time-consuming task of gathering various queries and service types and then consolidating them into a single response that could be absorbed into the health system’s EHR.
This was especially burdensome for a director overseeing various teams across the organization’s multiple locations. Their daily tasks included handling 3,000 patient accounts, with approximately 20% requiring time-consuming manual intervention. In addition to the administrative burdens faced by patient access staff, the impact on patients was noticeable. This was particularly true on the pre-service side, where delays in benefit responses resulted in hold-ups in cost of care estimates.
Availity worked with the health system to implement its Advanced Real-Time Eligibility (ARTE) feature available on Availity Essentials Pro™. The health system opted for Availity and its ARTE feature due to its ability to provide comprehensive eligibility results in one transaction. Availity’s full eligibility response is aimed to provide enhanced patient coverage insight while ensuring the health system incurs only one charge per inquiry and response transaction. Furthermore, with Availity Essentials Pro’s seamless integration into the health system’s EHR, staff members could efficiently request and access real-time patient eligibility and benefit information at the point of care. Highlighting the progress witnessed in financial estimations and the overall patient experience, the Director of Patient Access shared:
“We are very proud of our pre-service rate – not only for our hospital, but also for our patients – so they have transparency before their visit and are aware of financial liabilities. The patient gets their estimate quicker, which means they can better plan for their care. This helps meet our goals from a patient experience and payment collection perspective.”
Availity initiated a rapid implementation process. Adjustments were made to timelines, opting for a phased approach focused on defined payer groups to ensure confidence prior to full launch. Health system associates appreciated the flexibility and valued Availity’s support in strategizing a deliberate rollout rather than rushing for completion. Feedback indicated satisfaction with Availity’s customer service and regular communication.
Reduced eligibility denials by 67%, from 1,200 per month to approximately 400
Automated 35 hours of weekly work immediatly after implementing ARTE, increased payment collection by providing patients with cost of care estimates before their visit