Note: This is the third post in our Front-End vs. Back-End scoring series. This post comes from April Wilson, RevSpring’s Director of Analytic Products.
April Wilson uses her diverse data analytics background at RevSpring to help hospitals measure, optimize, and automate their patient communication effectiveness and RCM business processes.
When is the best time to use scoring in your RCM workflow?
In an ideal world, Revenue Cycle Directors could collect all cash owed for services at the time of service, without ever having to print and mail a bill. Patients would pay for 100% of their outstanding charges at time of service – and if they could not pay, complete an application for financial assistance.
The real world is far from ideal.
The hard reality is it can take 30 to 60 days before a patient ever receives their first bill. Then, most patients tend to wait until their second notice before making a payment. And when these payments do come in, they tend to be significantly less than the amount due – especially if the bill is over $500. Not to mention that patients who qualify for financial assistance may never complete or return applications, even after speaking with a Financial Counselor.
Using predictive models to score populations is a simple and effective way to identify a patient’s propensity to pay or likelihood to qualify for charity care. Much like credit scores are used in other areas of our lives to determine what we can pay on a mortgage or a car loan, healthcare-specific scores help revenue cycle directors make smarter and more customized decisions based on each patient’s financial situation.
When is the best time to score patients?
The answer is: it depends.
It depends on your existing infrastructure and processes. You know better than anyone else the lead time and impact of changing any process in the point-of-service engagement.
If you have older systems, fewer resources, and/or are in the process of making other big changes with staff, then it makes sense to implement scoring on the back-end. Your billing partner should be nimble enough to accommodate changes to patient communications based upon each patient’s score.
If you work in a more technology-focused organization, scoring on the front-end makes sense. In this scenario, organizations already have initiatives in place to leverage patient engagement best practices at point-of-service (such as mobile check-in, pre-registration, kiosks for payment, IVR and text reminders, etc.). If this reflects your current environment, it makes more sense to tailor all in-person interactions while the patient is still on-site.
Take baby steps
The beautiful thing about scoring is that it can happen anywhere in your existing RCM workflow. So technically, scoring makes sense everywhere.
If you are part of a more conservative organization, start by scoring at final notice, prior to bad debt placement. Find those patients in need with scoring and then re-classify those accounts as charity care.
As you get more comfortable with the process and start to see the results, you can then slowly start scoring earlier in your process.
Always be validating
Every 6 to 12 months, ensure your scores are still identifying the right patients for the predictive model or models. If your population changes and/or the score no longer validates, you will most likely be making poor billing decisions.
One best practice is to set up reports or dashboards to measure how well and how often the score is used to re-class accounts or offer discounts, before and after implementing scoring. This allows you to monitor any significant spikes or drops in patient populations across segments.