Double and triple booked provider schedules are overwhelming office staff

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Q. With patients now flooding into provider offices after some patients delayed care, front and back office provider staff are reportedly overwhelmed. The mix of manual and electronic processes was already a struggle prior to COVID-19. Could you please talk about this struggle and how it might affect hiring and retaining employees?

A. As the nation emerges from the COVID-19 pandemic, provider offices are inundated with patients who have not had routine and nonemergent care. Provider schedules are now double- and triple-booked with patients, and the volume is overwhelming the staff. In addition, some administrative staff are accustomed to working from home, and they may seek employment that allows them to continue the remote-work lifestyle.

These factors, along with increased responsibilities, skills, and education requirements, can make it hard to find a good practice administrator. Compensation should align with the increased expectations of this role to retain employees. According to the U.S. Bureau of Labor Statistics, the job outlook for healthcare administrators is predicted to grow by 32% by 2030. With the rising pressures and increased demand, provider practices will need to retain this talent or face a competitive landscape to replace these employees. 

Q. What are the top areas in the revenue cycle where administrative office help could use relief? Prior authorization? Denial of claims?

A. The three key areas where healthcare administrators experience the greatest frustrations are, claim attachments, denial management, and prior authorizations. Claim attachments are a point of contention for administrative staff because health plans have differing requirements. To alleviate that burden, providers should integrate a revenue cycle solution that includes an all-payer option for consistent processes across all contracted health plans.

Denial management is a second area where healthcare administrators could benefit from technology solutions. A recent Kaiser Family Foundation analysis reported claims denials were 17% in 2019, up from 14% in 2018. Provider practices spend a significant amount of time working on denials after a claim has been processed. Electronic solutions allow administrative staff to move the account and claim editing process upfront, improving administrative workflows and reducing days in account receivables.

A final and probably the biggest area to help provider administration is prior authorizations. Staff [members] report spending a significant amount of time and resources determining whether or not a health plan requires a prior authorization. Studies show that this can contribute to delayed patient care and higher administrative costs. Adopting electronic solutions can ensure a smoother process to help patients get quality care in a timely fashion.

Q. How has COVID-19 affected how work is done? Are more workers now working remotely from home, and is that expected to continue? What do you see as the future of the nonclinical hospital workforce?

A. When COVID-19 was declared a pandemic in March 2020, office staff went from the office to work-from-home nearly overnight, and staff went from calling or faxing paperwork to payers to having to learn new electronic systems. The pandemic has propelled technology adoption and showed the once resistant healthcare workforce how it can work more efficiently and effectively. While some front office staff will need to return to the brick-and-mortar office, other functions can more easily move to home offices. In the future, we are likely to see a mix of both in-office and at-home administrative staff.

Q. What technology is available and how can it help?

A. Many revenue cycle companies and clearinghouses exist to help relieve the burden of healthcare administrators by improving efficiencies. Most provider practices now have an EHR and a system that automates the claims and billing functionality, but office staff [does] so much more than billing.

For example, the front office staff utilizes technologies that check eligibility, deliver patient communications, schedule appointments, and accept patient payments. On the back end, staff uses technology to process claims, manage denials, handle payer contracts, and process health plan payments and remittances.

Revenue cycle solutions consolidate processes from pre-service to post-service and post-adjudication into a single workflow.

– Lillian Phelps is senior director for product management at Availity, a revenue cycle solutions business.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com