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Things to Consider When Building a Patient and Provider Engagement Infrastructure

This blog post is the final installment of our three part series. View Part One and Part Two.


On the recent Fierce Healthcare webinar, “Billing and Patient Access Tools to Boost Digital Health Profit,” I had the pleasure of addressing patient and provider engagement tools.

The fact is, healthcare billing and claims processing — more specifically the revenue cycle management (RCM) process for remote patient monitoring companies, medical device, diagnostic providers, hospital outpatient departments, and specialty physician groups — are complex and there are many things to consider when building tools and technology for patient and provider engagement. These considerations include the needs of:

Watch this featured portion of the webinar.

  • Patients – accessing statements, updating insurance information, making payments, setting up payment plans, and viewing test results
  • Provider offices – correcting errors or missing patient information, issuing electronic statements, identifying patient eligibility, and estimating the patient financial responsibility
  • Providers and physicians – consulting and collaborating with labs, entering an encounter summary, ordering tests, etc.

This post will describe how patient portals and client/physician portals can improve the experience for both patients and providers and expedite the RCM process. Examples of the capabilities provided by the XIFIN client portal include:

  • Self-service: Provides 24/7 access and information exchange such as documents and diagnosis codes.
  • Billing Error Correction: Automates requests and integrated updates by physicians and their staff of missing or invalid insurance and diagnosis information.
  • Uploading Documents: Physicians can securely upload and link supporting documentation to a specific patient for prior authorization, claims attachments, and appeals.
  • eBills and Pricing: Client/physician office invoices can be automatically delivered and paid via the XIFIN Client Portal.  Physicians can also look up pricing for the services provided prior to ordering a test or prescribing a medical device or service.  

Errors that would otherwise stop a claim from being reimbursed can be identified and corrected at order creation using accession validation tools. Web services can also leverage payor edits and validate diagnosis codes. These engagement capabilities provide real time connections between an RCM system provider, such as XIFIN, to patient services, client accounts, pricing, and payor files. Essentially, these tools make it easy to ensure consistency of data between disparate databases and validate data fields between databases.

Diving a little more deeply into eligibility, patient estimation, and prepayment capabilities, real-time eligibility checks at the right moment of the patient’s journey improves the patient experience, as does the ability to provide a patient an accurate estimation of their financial responsibility before ordering a test or prescribing a medical device or service. This accurate estimation upfront also provides the option to collect prepayments based on the estimate.

Payor-specific edits enable the validation required to prevent denials, better manage prior authorizations, and collect the data needed for a clean claim. Physician engagement is particularly important when it comes to getting the supporting documentation required for prior authorization, medical necessity, or clinical history. Typically, the types of information required from physicians includes:

  • Patient clinical notes detailing the relevant diagnosis(es)
  • Previous treatments/therapies (if applicable)
  • Relevant digital health findings, results, and patient data from use of a device, service or application
  • Why a device, application or service is being ordered
  • Proposed treatment plan
  • How the results of the service/test impact patient care

Appeals automation is another valuable RCM tool. It’s important to seek out an RCM system that has the capability to maintain payor-specific appeal forms. Users should be able to select a document from a drop-down menu to use as the cover letter for an appeal. In a letter preview, the user should be allowed to make any necessary changes. If free-form information is required, users should be able to do that at the same time. 

A patient portal is just as useful as a client/physician portal. Patient portals typically include capabilities such as:

  • Self-service: Patients can access and exchange information such as insurance and demographics themselves, anytime.
  • Payment Plans: Customers offer and manage payment plans including patient self-service payment plans.
  • Courtesy Letters: Communication before, during and after sending a statement helps improve the patient experience.
  • eBills & Notifications: Patient preferences on receiving and paying bills is critical including paperless billing/eBills and email or text notifications. 
  • Test/Monitoring Results: Makes getting results or findings easy.
  • Phone, text, and email: Offer different communication options, including integrated voice response (IVR), which helps serve patients via outbound calls and inbound call routing with interactive services such as payments.

Both patient and client portals served XIFIN customers well during the pandemic. With fewer office visits, patients needed digital alternatives. Sample changes in XIFIN portal usage can be seen below:

  • XIFIN Patient Portal – Feb 2021 compared against Feb 2020
  • 27% more XIFIN customers offering full portal functionality
  • 42% growth in number of payments made through the portal
  • 18% growth in average payment amount
  • XIFIN Client Portal – Feb 2021 compared against Feb 2020
  • 20% increase in ordering clients/physicians 
  • 35% increase in activity/actions performed
Client portals improve engagement with referring physicians by providing easy-to-use order entry, ability to review statements at the line-item level, access to testing information and prices, and much more. Likewise, patient portals improve the patient experience by offering the ability to access and update existing account information, view statements, and make payments anytime.

Learn about how XIFIN's patient and provider access tools have helped our clients improve reimbursement and patient engagement in this complementary on-demand webinar.

Watch Now

Published by XIFIN
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