Best Practices for Efficient, Effective Patient Access Operations 

The delays created by outdated patient access and financial clearance operations due to time-consuming and cost-intensive processes introduce inefficiencies that contribute to revenue leakage and lost revenues.

Streamlining the patient access process not only eliminates delays in the patient journey from initial contact to point of service, but it helps ensure patients’ financial security and timely access to necessary medical services. 

By implementing a synchronized financial clearance methodology centered around a well-designed and efficiently operated patient access team and modernized processes, revenues are accelerated through decreased payment delays due to front-end errors, as well as a reduction in rescheduled appointments and improved patient satisfaction.  

The engine that drives this patient access overhaul are new technologies and innovative solutions that streamline operations by engaging people, processes, and technology through collaboration and communication – an approach that also aids in greater revenue capture by proactively addressing patient eligibility and coverage issues before they become denials. 

Patient Access Best Practices 

Healthcare organizations can effectively enhance patient access processes and improve revenue through a combination of services, technology, and best practices. It starts with establishing a clear patient access strategy to ensure that all processes are aligned with the organization’s goals and objectives. This includes establishing key performance indicators (KPIs) and metrics to measure the success of the operation. Team members’ roles and responsibilities should also be clearly defined to drive accountability and ownership. 

Invest in the technologies that play an important role in optimizing patient access operations, e.g., electronic health record (EHR) systems, patient portals, and other digital tools that can streamline processes and improve patient satisfaction. Additionally, automating routine tasks such as online appointment scheduling and insurance verification can reduce wait times, improve efficiency, and reduce errors – all of which contribute to an improved overall patient experience. 

Other best practices to optimize patient access operations include:
 

• Standardize patient access procedures and underlying training organization-wide to ensure consistency, increase productivity, and minimize mistakes requiring rework. Standardized workflows should outline each step of the process and the expectations for each team member involved. As a bonus, when processes and training are standardized, future process changes or optimizations are more easily adopted.

• Conduct proper training and education on the technology and other tools used in the process. This is essential for the success of patient access operations and should be ongoing to ensure that staff are well-versed on changes in regulations and compliance requirements, as well as policies related to insurance coverage. 

• Establish metrics to track patient access performance, such as appointment wait time, insurance verification rate, prior authorization turnaround time, and patient satisfaction. KPIs should be defined, and metrics tracked regularly against benchmarks, to identify trends and patterns. Performance should be reviewed regularly to ensure that the operation is meeting its goals. 

• Foster a patient-centric culture to improve patient satisfaction and loyalty. Staff should be trained to focus on the patient’s needs and provide a positive experience throughout the process. Patient feedback should be solicited regularly to identify areas for improvement and address any issues promptly. 

An effective patient access operation requires a clear strategy, investment in technology, standardization of processes, proper staff training and education, performance measurement and monitoring, and establishment of a patient-centric culture. By following these best practices, healthcare organizations can optimize their patient access operations, increase revenue, reduce costs and denials, and improve the overall patient experience. 

Real-World Best Practices 

An excellent example of the impact these best practices can have on patient access operations is the use of an “intelligent authorization tool” by US Radiology Specialists, which operates more than 180 outpatient imaging centers in 14 states.  

By automating and optimizing prior authorizations, daily staff production doubled from an average of 60 to 120 cases per associate, while the percentage of scheduled exams requiring manual intervention fell to just 5-10 percent. Automation also enables the US Radiology team to work authorizations further in advance from the date of service, improving from an average of three days out to nine days out. 

These improvements allow US Radiology to provide patients with more timely access to care and schedule appointments in advance to fill unexpected gaps in schedules, all without requiring an increase in full-time staff.  

As a result of implementing intelligent authorization tools, US Radiology realized significant operational efficiencies, reduced denials, and improved overall patient satisfaction. 

Optimized Patient Access 

Leveraging a powerful combination of automation tools and proven best practices enhances efficiencies, streamlines workflows, and creates the foundation for optimized patient access operations. The result is a synchronized financial clearance methodology that eliminates many front-end errors that create delays and drag down revenues.