Three Ways to Reduce Radiology Patient Friction in the Revenue Cycle

By Tom Herald

The consumer-driven healthcare era has transformed the role of the radiology patient. Today, patients are more informed about their treatment options and what they will have to pay out-of-pocket. Driven by a desire to obtain affordable healthcare, patients seek providers that align with their overall needs without compromising care.

The evolution of the healthcare business model corresponds to the development of the payment process. What once was a business-to-business transaction has been replaced by something more complex and difficult to navigate — a business-to-business-to-consumer model. In a business-to-business model, a radiology practice would file a claim to the insurance company who would then adjudicate the claim and pay the practice for services rendered.

In the business-to-business-to-consumer payment model, radiologists have to send the insurance company a bill and get it adjudicated. The insurance company may well come back to the radiology provider saying a patient owes the deductible, so the provider then bills the patient for that deductible. After billing the radiology patient for the deductible, the radiologist has to get that payment adjudicated by the insurance company and only then can the radiologist bill the patient and collect for the services rendered.

This model has taken shape due to rising deductibles and copayments. In 2016, covered employees had an average deductible of $1,478 for single coverage, up from $1,318 in 2015, according to data from the Kaiser Family Foundation. Additionally, many covered workers have copayments. Sixty-seven percent of covered workers have a copayment for a primary care visit. For primary care, the average in-network copayment totaled $24 in 2016. An InstaMed study found the number of consumer payments to healthcare providers increased 193 percent between 2011 and 2014.

Therefore, radiology practices will need to employ the right tools to make this process as painless as possible. As higher premiums and deductibles propel healthcare organizations into more consumer-facing interactions, radiology groups today understand they can no longer solely focus on the clinical side of care. They must also understand the revenue cycle management process and ensure patients have the information they need to follow through on payments. Revenue cycle management technology can assist practices as they seek to collect payments from their patients while also creating a satisfying experience.

How to limit friction in the payment process

Friction is defined as any irregularity to an otherwise smooth payment process. When radiologists fail to effectively manage claims and obtain the necessary information from patients to avoid payer denials, they risk creating diversions in the payment process that can harm the patient-provider relationship and create friction.

For instance, a radiologist could obtain an inappropriate denial from an insurance company, which raises a slew of questions including whether the administrative team received all the correct information from the patient. This could be a product of a staff member failing to verify a patient's information or a patient hastily writing down their information and making an error in the process. Nonetheless, friction occurs and this is a phenomenon radiologists must work to avoid in their RCM process.

Recent data found almost 30 percent of all claims are either inappropriately denied or inappropriately paid. Of that 30 percent, half of claims are not followed up on. In those cases, a radiologist is essentially walking away with nothing. For instance, if a patient calls and complains, that's friction in the process. Critical is the amount of patient friction in the process and how it is measured, which depends on how clean the data is, how the carrier processes the claims, or the ability of a patient to pay. Friction is any exception to the payment process.

Technology can be used to assess to determine potential friction points, including a patient's propensity to pay, the insurance company's likelihood of denying or sending inappropriate denials and the radiology practice’s consistency in relaying accurate insurance or payment information to the patient. However, all of this information must be 100 percent correct because inaccurate information can completely alter a specific patient's estimated friction.

Reducing patient friction with technology

If practices successfully employ technology to determine an estimated amount of friction, they can then fine-tune the best next steps to boost a patient's likelihood of paying. Catering technological solutions to each patient means they will likely use platforms that best suit their needs and preferences.

For instance, Zotec Partners, the largest provider of radiology revenue cycle management services in the U.S., personalizes patients’ profiles based on what they are most likely to appreciate in terms of collection methods. So, if a patient is a millennial, they may want a text telling them to pay online, whereas a 70-year old patient may want to receive a text because their grandkids are texting, but they may also want to hand-write a check and mail that in. There are many ways that radiology providers can work closely with patients during the time of service and beyond to limit friction. Below are three options:

  1. Propensity to Pay: Through individualized platforms, the payment process is easier for patients and will likely translate to a higher propensity for patients to follow through on bills. As the industry continues to trend toward the consumer, radiology practices cannot forgo the importance of minimizing friction, particularly because value-based outcomes and patient satisfaction scores dictate payments.
  2. Patient Portal for Preferences: Options including patient portals allow patients to stay updated on their insurance information and set up payment plans through a text or integrated voice response system. In fact, texting is a preferred method of communication for a large portion of patients, and using a platform that bodes well with patients will fare well for radiology practices in receiving payments.
  3. Eligibility Verification: Technology can also minimize the likelihood of a denial due to inaccurate or incomplete information. The ability to compare a claim to a patient's policy information to ensure there aren't any discrepancies that would prohibit a provider from receiving payment in full is key to a seamless transaction. Additionally, conducting eligibility checks and verifying statements prior to sending those to patients can also reduce friction.

In summary, a healthy blend of customer service and technology can help radiology practices avoid friction that impedes a successful payment process. Radiology practices that fail to prioritize the consumer will fall behind their competitors, both in terms of reputation and finances, as patient satisfaction is a core component of the value-based healthcare era. Letting the patient billing experience fall to the wayside may cost radiology practices significant amounts of money, which is where a revenue cycle management partner comes into play. With the rise of high-deductible health plans, patient-focused care is here to stay, and radiology practices can and should prepare to thrive in this landscape.

Tom Heraldserves as Senior Vice President, Radiology with Zotec Partners (Zotec), an industry-leading provider of radiology revenue cycle and practice management services. He is specialized in radiology and radiology billing and oversees radiology client service nationwide for the company and its clients. He is a member of the Society of Interventional Radiology and serves on the Coding and Economics committee as well as serving on the Programs Committee of the Radiology Business Management Association. He can be reached at therald@zotecpartners.com.