Patient financial clearance systems in the US healthcare are antiquated and inefficient. The time has come to understand these systems better and modernize them from the ground level up.

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The business of running a profitable sleep center has seen seismic shifts in the last few decades. Traditional patient eligibility and benefits verification systems used in sleep centers are quickly becoming inefficient and inadequate. These systems were originally designed to simply confirm that a patient is eligible for insurance. However, modern sleep centers fight with complex information exchanges and ever-changing requirements from the payers.

As demand for sleep center services soars amongst patients, outdated insurance verification processes continue to pose operational challenges for practices that require more advanced systems to provide accurate and efficient care.

A study by the American Sleep Medicine Association (AASM) found that the average sleep center deals with about 20 different insurance companies in a day. The process of logging into individual online insurance portals for each patient, interpreting coverage information, and in some cases, being on the phone with insurance companies for hours can be tedious and frustrating for both the patient and the sleep center staff -- especially when patients are anxious about their upcoming sleep study or treatment. Long wait times, complex paperwork, and denied claims can all contribute to delays in care and financial losses for sleep centers.

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When EHRs aren’t enough

You know the feeling of being trapped in insurance purgatory. You've spent hours on hold, only to be disconnected or transferred to someone who can't help you. Your staff is feeling the same way, and your patients are starting to get frustrated.

Here are a few factors that could be further contributing to operational issues:

1. Incomplete Eligibility Information: Many sleep centers rely on Electronic Health Records (EHR) for insurance verification, which often provides only basic information about a patient's insurance status. It checks if the insurance is active or not but doesn't provide detailed benefit coverage information. Third-party billing vendors also struggle with manual tasks and are forced to work with multiple portals, which can lead to delays and errors.

2. Lack of Service-Level Benefits: To efficiently plan and provide services, sleep centers need service-level insurance benefits. Generic insurance verification software may not offer this granularity, leaving staff to interpret vague benefit summaries -- and often wasting time to confirm the benefits again with insurance companies over the phone.

3. Specialized Sleep Medicine Services: Sleep centers often offer specialized services like diagnostic tests and CPAP treatment, which may not have clearly defined coverage and benefit information from insurance providers.

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4. Manual Data Summarization: Even if staff can access benefit information online, they often spend significant time manually summarizing and recording this information for each patient, leading to inefficiencies.

5. Patient Estimates: To communicate patient financial responsibility accurately, the benefits information must be summarized clearly. Sleep centers often lack the best practices in how to communicate the patient's financial responsibility, resulting in confusion and poor collection from the patients.

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The pitfalls of inaccurate or missing patient's information

Inaccurate or missing insurance information can have profound consequences for sleep centers. Patients who are uncertain about their out-of-pocket expenses may cancel appointments or not show up, impacting revenue and patient care.

• Claim Denials: An alarming percentage of claim denials are attributed to errors in obtaining accurate insurance verification information. These denials translate into revenue losses and administrative headaches.
• Patient Dropouts: A significant portion of patient dropouts can be attributed to concerns about out-of-pocket financial responsibility or delays in obtaining appointments due to insurance verification issues.
• Staff Productivity: On average, sleep center staff spend a substantial amount of time per patient to secure financial clearance. This manual process not only hampers productivity but also contributes to staff turnover.
• Appointment Delays: The average number of days of delay in setting up a patient appointment due to lack of insurance coverage clarity is a key metric. Delays can lead to frustrated patients and missed revenue opportunities.

The good news is that there are things you can do to improve the efficiency of your insurance verification process. Modernizing the insurance eligibility and benefits verification process with intelligent workflow automation is one way to address the problem at hand. Thus, eliminating the necessity of navigating various record systems to initiate timely care and ensure accurate reimbursements.

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What is Intelligent Workflow Automation for Sleep Centers?

Sleep centers face ever-increasing complexities in payer requirements, patient financial clearance processes, and other mundane tasks. Intelligent automation can help sleep centers to adapt to these challenges by automating tasks such as pre-registration and eligibility and benefits verification.

Patient insurance data, including service-level coverage info and patient estimate, can be consolidated in a simple summary sheet that is now easily comprehended by the patient access team at your practice.  

A modern system such as Aarogram's SmartVerify Insurance Engine can pull patient's eligibility and verification data from various insurance companies and other sources using API or bots, parse the data for an accurate service level info and summarize in a simple sheet for consumption of the staff or the patient alike. This can conserve tens of hours' worth of time each week and free up staff members to focus on more complex tasks. Intelligent workflow automation can allow free staff members to focus on more complex tasks, such as providing personalized care to patients, managing complex submissions, and improving the patient experience.

The future of benefits verification in sleep centers lies in intelligent, connected systems that streamline the process from start to finish. By adopting advanced platforms like Aarogram's SmartVerify, sleep center managers and owners can optimize operations, enhance patient care, and boost their bottom line. Achieving a frictionless insurance verification experience requires not just accurate coverage data but also efficient data management and communication.

A solution like Aarogram's platform automates the entire process in real-time, empowering staff to make informed decisions and provide financial clearance to patients promptly. Aarogram's SmartVerify system is an intelligent workflow automation solution that integrates easily with existing systems including EHRs at sleep centers and other types of practices. It automates workflows related to eligibility and benefits verification, prior authorization, and payment summaries, which can help sleep centers to reduce administrative costs, improve efficiency, reduce the risk of errors, and provide better patient care.

To learn more about how Aarogram's SmartVerify system can help your sleep center automate payer requirements, improve patient experience and bring cost efficiency, feel free to contact us.