5 Key Reasons “Access” and “Revenue Cycle” Support Are Different

Considering the budgetary challenges facing healthcare providers today, it’s not surprising many are looking to outsourced partnerships as a means to find efficiency. Two of the most common areas for this are Patient Access and Revenue Cycle management. Since both are supported mainly through call center operations, it’s sometimes difficult to understand how the work behind access and revenue cycle call centers are different and what to look for when choosing to outsource either or both functions to partners. On the surface, it may seem convenient to utilize the same call center for both functions, but there are significant underlying differences to note before determining the right solution for your organization including…

1.    Focus and Expertise 
Patient access and revenue cycle management are distinctly different functions that require different skill sets and knowledge. Patient access call centers are responsible for tasks front office tasks such as appointment scheduling, referral management, medication refill and clinical triage support. These tasks require a significant amount of customer service and patient satisfaction training and a sensitivity to tone and need of the patient. Meanwhile, revenue cycle management processes can focus on supporting the pure financial management processes; including coding, authorizations, and payment reconciliation. These functions require different training, workflows and expertise that are difficult to share within the same call center structure. Any negative customer service experiences in the access space can lead to disappointed patients and a negative consequence on patient relationships and experience.  

2.    Conflicting Priorities 
Patient access and revenue cycle management have different goals and priorities. Patient access call centers aim to provide exceptional patient experiences by ensuring smooth and convenient access to healthcare services. On the other hand, revenue cycle management focuses on optimizing billing and collections to maximize financial reimbursement. These contrasting objectives can create conflicts in resource allocation, quality metrics, and customer service approaches… not to mention difficulties in agent training and performance monitoring. By understanding the differences in functional performance, you can align your goals and strategies alongside what each function provides and determine the appropriate mix with the highest degree of return on investment. 

3.    Patient Experience and Satisfaction 
Patients expect a seamless and personalized experience when interacting with healthcare organizations. By recognizing the key differences between patient access and revenue cycle management, you can ensure that patients receive focused attention and support tailored to their needs. Consolidating these functions can result in poor service, inefficiencies, and delays in addressing patient inquiries and concerns. And let’s not ignore the stark differences in approach… Patient Access representatives require an empathetic approach as they directly connect with patients who are seeking care, often in pain or under stress— Collection agents on the other hand are not exactly known for their delicate touch. The potential for addressing both access and billing on the same call (a touted benefit of combined call centers) presents problems; either agents must make a hard switch in attitude or patients must endure a transfer to a different agent— neither of which boasts well for the experience. 

4.    Compliance and Data Security
Both patient access and revenue cycle management involve handling sensitive patient information. Patient privacy and data security are critical aspects of healthcare operations, ensuring compliance and the welfare of the organization as well as its reputation with its patient community. Separating the call center functions, and thus separating health and financial data, helps maintain better control and security over patient data. By segregating the functions, you can implement appropriate security measures, access controls, and compliance protocols specific to each area— reducing the risk of data breaches and ensuring compliance with relevant regulations like HIPAA.

5.    Workflow Optimization 
From an operational perspective, combining access and collections creates issues around workflow optimization. Patient access and revenue cycle management processes have very distinct workflows and timelines. Combining these can create bottlenecks, inefficiencies, and delays. By separating the call centers, you can streamline the workflows, optimize processes, and ensuring each function operates at peak efficiency. This results in improved productivity, reduced errors, and faster resolution of patient inquiries, contributing to a positive overall organizational performance.

Maintaining separate functions for access and revenue cycle management within your call centers for patient access and revenue cycle billing and collections is essential for the effective and efficient operation of your healthcare organization. Attempts to cut corners by combining these functions can backfire in ways detrimental to not only revenue collection but also  access which controls revenue potential. By dedicating specialized teams to each area, you can ensure focused expertise, aligned priorities, and an enhanced patient experience that supports lasting patient relationships. These benefits ultimately lead to improved patient satisfaction, financial performance, and overall organizational success.

Envera Health provides fully customized Patient Access solutions, built around the unique needs of your organization and patient community. 

Contact us for a consultation today.