Coordination of benefits (COB) and other patient information denials rank among the most common hospital denials, and they are a source of frustration for patients and a revenue drain for hospitals. The key to success: patient centricity. A multi-pronged approach that puts primary focus on a patient’s perspective and engagement can improve the hospital’s revenue recovery and reputation with patients.
5 Ways to Improve COB and Patient Involvement Denials Using Patient Centricity
Many eligibility and missing information denials stem from processes or communications that don’t put enough consideration on the patient’s importance in revenue cycle workflows. Front-end processes that don’t gather the right information, misclassification of claims, and ineffective communications are just some of the challenges that healthcare organizations often have to overcome as they strive for more patient-centric processes.
Here are five practical ways to create a patient-centric approach for reducing COB and patient information denials.
1) Recognize the Importance of Proper Classification in Your Denials Management Workflows
Often, staff identify these denials as “patient responsibility” when efforts to reach patients for more information fall through. The impact of a self-pay classification can be substantial, often contributing to aging A/R and bad debt. Instead, revenue cycle leaders should ensure staff understand why they should wait to categorize COB and patient information denials as self-pay until efforts to resolve claims are exhausted.
At one multi-hospital system, failing to correct COB claims led to $1.2 million in lost revenue per month.
2) Involve Patients Early in Benefits Discussions
Also important is training patient access staff on the right timing and approach for asking whether patients are covered by more than one plan. Help your revenue cycle team understand the intricacies of COB requirements—including the birthday rule—and make sure they know which payer to bill and when.
Review all information the patient is providing, including the Medicare Secondary Payer Questionnaire (MSPQ), and have COB forms readily available for patients to complete.
3) Recognize that Patient-Centric Communication Includes Channel Preference
While your organization may pay attention to scripting revenue cycle communications with patients, it also should consider channel diversity when focusing on patient engagement for denials management. In our experience, multi-channel patient communications—from texts to emails, auto-dialers, letters, and even face-to-face communication—produce optimal results. Not everyone is responsive to the same types of outreach, so offering communication across different channels increases the likelihood of successfully meeting patients’ diverse communication preferences.
We’ve found that the style of the envelope matters when mailing print communications. For instance, colorful envelopes and mailers are more likely to spark a response than standard business envelopes.
4) Create Processes for Repeated Follow-Up
Typically, a “once and done” approach to patient and payer communication is not sufficient. Denials Management workflows should build in multiple reminders for patients to provide their information and include triggers for when revenue cycle staff should contact health plans to confirm that no additional information is needed for payment of the claim.
When it comes to contacting patients, the time of day can make a significant difference in whether and how patients respond.
5) Ensure Your Resources Support High-Touch Needs
COB and patient info denials often confuse patients and can cause enormous turmoil at a time when patients might already feel vulnerable due to their health status. Revenue cycle leaders should consider what sort of barriers to maintaining a patient-centric approach might be present in busy day-to-day revenue cycle functions. If service is likely to be impacted by competing priorities, ask yourself: “Is my staff’s time best spent on these COB activities, or is there a greater return on investment from outsourcing this work?” An outsourcing company such as Knowtion Health will not only have the right COB expertise but also will have a team that has the bandwidth to maintain high service to patients, sometimes even conducting a home visit to resolve particularly troublesome denials.
COB and patient info denials put on average 1 percent of revenue at risk each year, and they can be too time-consuming for busy in-house revenue cycle teams to solve.
Implementing a Patient-Centric Approach to Denials Management
Taking these steps will help your patients understand what is needed by insurance companies so their claims are paid and don’t wind up as patient responsibility—and a negative patient experience. The best news: COB recovery rates total as high as 75 percent when organizations invest in outside support, and that can mean a stronger bottom line.
Revamp your COB recovery strategy with an expert team. Knowtion Health serves over 350 hospitals in 40 states, helps improve the patient experience, and accelerates and resolves COB and patient information denials. To learn how Knowtion Health can improve your organization’s COB and denials management program, visit Services@KnowtionHealth.com.