Revenue Solutions: Financial Clearance | FTI Consulting

Revenue Solutions

Financial Clearance

Health Solutions | Healthcare & Life Sciences

June 20, 2018

Consolidation and standardization of upstream revenue cycle functions into a centralized Financial Clearance Department can increase net revenue and decrease bad debt while improving patient and provider satisfaction.

Introduction

It is an era of consumer‐driven healthcare, price transparency, stringent authorization requirements, and complex benefit plans. Those pressures make it more important than ever for health systems to have sophisticated processes for financially clearing all services prior to arrival (for outpatients) or prior to discharge (for inpatients). As more consumers are opting into high‐deductible plans, price shopping and upfront requests regarding their financial responsibility are becoming common. Provider organizations need to be equipped to answer patient inquiries.

Robust, centralized pre‐arrival Financial Clearance models can improve an organization’s bottom line by preventing insurance‐ and authorization‐related denials, decreasing bad debt, and increasing upfront collections. The same models can also improve patient and physician satisfaction by streamlining registration and enhancing communication.

FTI Consulting Approach

FTI Consulting teams approach the challenge of optimizing our client’s financial clearance through three key components: infrastructure, processes and technology.

Centralizing financial clearance functions across multiple hospital and ambulatory departments can be challenging from a workforce management perspective when resources are being combined from different cost centers. FTI Consulting can assist with estimating the work effort being extracted from each department or specialty and, using industry benchmarks, will translate that into workforce requirements for a centralized team. Additionally, we plan for migration of FTEs and functions, create or adjust job descriptions, and develop career paths for employees.

The FTI Consulting approach to process re‐design is to streamline and standardize all processes through collaborative design sessions with key revenue cycle stakeholders. Our experts bring best practice standards and prior implementation experience to the table. We consider each organization’s nuances to help develop the best fit future state model. Our design phase covers all functional areas and sub‐processes within Financial Clearance ‐ the output of which are documented workflows, standard operating procedures, and job aids to support employee performance.


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