Front-End: Patient Access
End-to-End Patient Access
Past revenue cycle best practices focused on back-end medical billing services and collections processes. However, in this new era of patient-centric healthcare, healthcare providers must shift their focus to the front-end of the revenue cycle management to succeed.
Sutherland helps health providers to achieve a patient-centric model through a range of proven business-to-consumer billing services, methods and techniques from other consumer-driven industries, such as hospitality and retail. This helps providers to transform their revenue cycle, from the front-end to the back-end. Our end-to-end patient access services lower denials rates, increase total collections, and improve the overall patient experience.
Digital Order Management
The medical billing process has become more complex than ever through the large number of mergers, partnerships, and new acquisitions in the healthcare space. This has created chaos for health provider’s staff as patient information is often inaccurate, information isn’t easily shared with all stakeholders, and orders go unfulfilled.
Sutherland helps to solve this chaos through our digital order management services. Our services help health providers automate disparate clinical and financial information entry and aggregating into a single, easily-accessible medical claims management system. The end result is health providers are able to create, receive, review, and track orders to and from physician offices, surgery centers, labs, and other stakeholder departments.
Even in today’s digital world, it’s still incredibly complex for a patient to schedule an appointment. This issue not only hurts health providers’ bottom-line but it negatively impacts the patient experience. A patient should be able to quickly call or go online to schedule an appointment and update their information.
Sutherland’s central scheduling solutions help health providers accomplish this task. Our medical practice management software solutions allow for patients to easily schedule an appoint – whether online or by phone – and engage with them so all the necessary patient information is updated and accurate before they step foot into the office. This creates a more seamless patient experience, reduces costs, and increases efficiency for health providers.
A critical component for improving front-end revenue cycle management is the pre-registration process and electronic claims processing. By confirming the patient’s insurance coverage and acknowledging the patient’s financial responsibility before the appointment, healthcare providers can make major improvements to their bottom-line by leveraging medical billing software and an electronic claims processing system.
Sutherland has helped health providers digitize and transform their pre-registration process. By creating an integrated and digital pre-registration process, health providers can improve patient satisfaction, lower costs, and increase their cash collections.
Patient Registration Quality Assurance
Health providers must eliminate their costly delays in their medical billing and insurance processing due to registration errors. This not only impacts their bottom-line but also decreases productivity for their front-staff as these errors can be timely to investigate and resolve.
Sutherland’s team of revenue cycle experts review every step in the patient registration process to ensure the best processes are being implemented at every touchpoint. We observe problematic areas and then employ our digital team to assist in creating an automated solution. This results in significant savings in time and increases cash flow in the revenue cycle by avoiding registration and medical billing process errors.
Demographic and Insurance Verification
Creating a holistic and simplified revenue cycle process starts by revamping the front-end. By verifying a patient’s demographic information and health plan coverage, health providers can avoid back-end revenue cycle issues, positively impact their bottom-line, and improve patient satisfaction.
Sutherland helps transform the demographic and insurance verification process for health providers. We simplify and digitize to more quickly register patients and create a compelling experience.
Pre-Certification and Authorization
Improving the pre-authorization process can advance the speed of payments and reduce write-offs. Most importantly, it creates an improved patient experience by providing a clearer financial picture to the patient before their services are completed.
Sutherland works to re-engineer the pre-authorization process on behalf of our health provider clients. Our specialists partner with our clients, their patients, and health plans to obtain the necessary information to get approved pre-authorizations in place. This helps to minimize denials, improve collections, and, most importantly, improve the patient experience.
Medical Necessity Checking
Medical necessity denials are some of the most costly and complex issues health providers face today. While less prevalent in today’s healthcare, there are still many provider organizations that perform the medical necessity checking at the back-end, after a patient’s procedure has been completed.
Sutherland helps health providers to rework their medical necessity processes. We will ensure the services are performed before the patient has the procedure, the diagnoses and documentation support the care provided and we will automate redundant parts of the process.
Financial Counseling with Propensity-to-Pay
Patients continue to bear more financial responsibility in today’s healthcare environment. Health providers can no longer ignore the patient’s educational needs. They must first understand the likelihood of a patient paying their bills and then provide financial counseling programs to increase their overall collections efforts and improve patient satisfaction.
Sutherland delivers financial counseling services and propensity-to-pay services to our health provider clients and their patients. We first inform patients about their overall costs, options on government programs available to provide assistance, and advise on how best to handle their financial obligations. This packaged offering improves collection rates and decreases expenses on the back end of the revenue cycle.
Patient Liability Estimator
The ability to provide an accurate liability estimate to a patient prior to procedure completion is one of the most promising developments health providers can undertake. By giving patients this information, they can better understand their cost options, mentally prepare to submit payments, and deliver their financial obligations when it comes time to collect.
Sutherland provides patient liability estimating solutions that help in the verification of insurance and provides a calculation of applicable out-of-pocket costs to be collected at the time of the service and afterward. Our patient liability estimator improves patient preparedness and increases bottom-line revenue through improved collections of patient payments.
Back-End: Patient Accounting
Billing and Collections
Even though the revenue cycle is undergoing a shift in focus to the front-end, the back-end is still a vital component for health providers. The proper billing of services and collection of payments from all parties responsible is instrumental to the success of the provider organization.
Sutherland understands the importance of back-end revenue cycle billing and collections. We work to proactively prevent back-end revenue cycle issues by digitizing front-end services. We will also work to improve existing back-end processes through automation and business process transformation. Our medical billing management services help move insurance claims along to maximize the collections process.
Legacy A/R Conversions
Converting electronic health records and Health IT systems is a complex process and can jeopardize a health provider’s financial health. Critical decisions must be made about the accounts receivable in the soon-to-be-legacy electronic medical records system to effectively maximize the receivable's value and maintain financial stability.
At Sutherland, we walk step-for-step with our health provider clients during their system conversions. We work closely to mitigate the financial risk associated with system conversions to maximize collections. Our clients are then able to focus on training their staff without worrying about the financial future of the provider organization.
With increasingly complex contract terms and the proliferation of insurance, it is more important than ever for health providers to verify their contracted health plans are complying with the correct insurance claim terms and payment schedules.
Sutherland leverages a leading-edge contract compliance to ensure our clients receive correct reimbursements from their insurance claims. Our services help to identify underpayments from insurance companies and initiate the process to recover lost revenue. Our staff is trained to manage the entire revenue and ensure compliance with contracted health plans.
Denials Management: Technical and Clinical
It is estimated that denials cost organizations about 3% of their total net revenue. Uncoordinated denial naming conventions, haphazard denial posting methodologies, inability to prove medical necessity, and a lack of medical office technology have all made it tough for health providers to properly handle their denied claims.
At Sutherland, we will quickly identify the type of claims denials plaguing our clients and begin the process of collecting all receivables due. We then implement more proactive and strategic processes by conducting a root cause analysis to identify and target problem areas that affect provider’s bottom line.
Payment posting is a resource-heavy process. Cash is checked and then applied to the individual account. If there is any sort of overpayment, denial, or underpayment made, a staff member must immediately communicate and correct the issue.
Sutherland will manage this process to increase payment posting efficiency. We do this by investigating the back-end revenue cycle process to identify recurring issues, improve existing processes, and leverage automated payment posting tools. The end result is decreased costs and increased efficiencies.
Patient Contact Center
Healthcare is complex and patients are understandably bound to have questions. Patients want to know their financial responsibility, they want to understand a procedure, or they might have a post-procedure question. It’s important to communicate with empathy and understanding to help them handle any questions or concerns they might have.
Sutherland’s highly rated patient contact centers are deployed to give patients a quick and easy way to ask questions, schedule appointments, and understand their various cares options. Our staff understands these needs and is trained to provide exceptional service. This drastically improves the entire experience for one of the most personal services in the world; a patient’s health.
The growth of self-pay patients has increased exponentially over the last several years. Patients now own a larger-than-ever portion of their total cost of healthcare and health providers are struggling to keep up with this change. It’s become far too common of a situation where patients can’t make their payments and health provider’s accounts receivables go up, bad debt sky rockets, and overall revenue collections go down.
Sutherland is a leading provider of revenue cycle services to self-pay patients. We empower self-pay patients with our patient liability estimator so that they know the cost of their service and their financial obligations. We then work closely with our clients to help reduce self-pay receivables, increase cash flow, and reduce bad debt.
Knowledge is power. With margins tightening and different forms of payment models being implemented, it’s more important than ever for health providers to stay up-to-date on their overall medical practice management, revenue cycle performance and medical billing solutions.
Sutherland’s dashboards and reporting capabilities help health providers quickly catch and address issues that prevent cash from being collected. Our reporting capabilities and analytics tools help health providers drill into financial metrics, perform analyses at the most granular level, and identify trends in data.
As healthcare transitions to value-based care, health providers need to create a plan to adopt analytics into their revenue cycle operations. Revenue cycle analytics are instrumental to keep a hospital running and to avoid significant revenue loss as healthcare moves away from fee-for-service.
Sutherland's portfolio of analytics capabilities helps health providers capitalize on the new digital era of medical practice management. Our analytics experts handle many complex situations including network referral leakage, variations in quality of care, and help to identify trends in data.
Government Reporting Management
There is no shortage of government reporting requirements in healthcare. Whether it’s for Medicaid, Medicare, or a charity care program, health providers must record, report, and stay in compliance with numerous government reporting regulations.
Sutherland helps to ensure department compliance with government reporting and reimbursement procedures when it comes to revenue cycle operations. Our programs strive to improve back-end revenue cycle processes while also complying with government reporting regulations.
Credit balances are accounts on the receivables side which have payments exceeding the total charges. Credit balances are no different than any other process within the revenue cycle in that they require careful attention to detail and patience to get it right.
At Sutherland, we provide dedicated credit balance resources to supplement our client’s staff. We begin by reviewing the credit balance reports and identifying patient and insurance refunds. Next, we initiate the refund process and deliver supporting documentation to all involved parties. After, we identify overpaid accounts and correct so all accounts are billed timely and correctly.