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Need evidence of healthcare’s continuing financial challenges? Recently, Moody’s announced not-for-profit hospital margins are at a 10-year low. Congress continues to look at more budget cuts in federal reimbursements. The ACA continues to lose members, pushing people back to the uninsured ranks. This does not paint an inspiring revenue picture in the immediate future, and organizations are looking at how to do more with less.

Knowing how to deal with insurance hold times is an important factor in pursuit of better productivity. When you consider any revenue cycle process, calling insurance companies to get the status of a claim is clearly a large labor-intensive function. And any analysis of a business’s budget will show labor is the biggest expense line item. Healthcare is no different. Reducing the amount of time your reps spend on hold with insurance companies is a tactic to improve bottom line results.

How much would it help, realistically? Horror stories of 60-minute wait times for a payer rep to answer are common – But those are the outliers. According to our analysis of thousands of calls and a multitude of payers, it takes eight minutes, on average, to navigate the IVR, and wait on hold to get a payer rep on the line.

Eight minutes may not seem like a ton of time, but when you consider the number of calls one of your agents can make in a typical day, the amount of time wasted just to talk with a payer rep is significant. Do the math: Check your agent’s daily stats and look at the number of accounts they work in a day. Take that average number of accounts and multiply by eight minutes. You will likely see as much as a third of their time spent waiting for the payer rep to pick up.

Think about that: A third of your most expensive resource is taken up by time spent waiting for a payer rep to answer. In an age of automation and AI, bearing this issue isn’t a necessary path to raise productivity. Adopting innovative tactics can significantly reduce the time your reps spend on hold and navigating IVR.

Let’s look at some ways you can cut down on this wasted time:

  • Use payer data to determine when you should call – Basic data like how long on average it takes a payer to respond to a claim should be easy data you can capture and use. If it takes a payer 21 days to issue their first response, then why waste resources calling the payer? There are other tools you can use instead.
  • Stop calling – In the first 2-3 weeks after a claim is filed, it is a better idea to use an AI tool to check the status of the claim from the payer website. This is not standard EDI transactions but AI that can review a website for the data you need. This technology exists today – use it instead of calling and/or checking the website manually.
  • Use concurrent calling when calling a payer – When you do have to make a call to the payer, use concurrent calling to reduce the time your agent has to wait on hold. If you know the average talk time is eight minutes and your average hold time is 8 minutes then time a second call to the payer so that the call is ready soon after you hang up on the first call.
  • Look ahead while on the call with the payer rep – Work as many claims as possible when you get on the phone with the payer. It may seem obvious, but make sure you sort claims by the biggest value and the correct payer. Are each of those claims open in tabs on the agent’s screen so navigating between each is as simple as one click? Will the recording be properly concatenated on each claim? These productivity tools each make the process faster and more efficient.

For a long time, we’ve all known calling payers was very inefficient, and a waste of a valuable resource’s time. Quantifying this wasted effort is a good way to see just how much opportunity you have. Technology has always been slow coming to the healthcare revenue cycle, but now it has arrived. Look at some of these tasks and see how you can make your agents more productive in these challenging financial times.

Download this ebook to learn how you can boost productivity and recover more revenue.


Disclaimer: Ontario Systems is a technology company and provides this blog article solely for general informational and marketing purposes. You should not rely on the content of this material for any other purpose or as specific guidance for your company. Ontario Systems’ advice, services, tools and products described herein do not guarantee compliance with any law or industry standard. You are ultimately responsible for your own company’s actions and compliance efforts. Because everyone’s situation is different, you must consult your own attorneys, accountants, and/or other advisors to obtain specific advice on your company’s compliance, legal, tax, regulatory and/or other business needs. Despite Ontario Systems’ efforts to provide current and up-to-date information, you need to recognize that the information contained herein may become outdated quickly and may contain errors and/or other inaccuracies.

© 2018 Ontario Systems, LLC. All rights reserved. Information contained in this document is subject to change. Reproduction of this publication is not permitted without the express permission of Ontario Systems, LLC.

Posted by Shawn Yates

Shawn Yates serves as Director of Product Management for Ontario Systems, defining the company’s strategy for product and service offerings in the healthcare market. With over 20 years of experience managing self-pay receivables and collection operations for a top 20 healthcare system, Shawn’s background also includes working for a national outsourcing company helping clients manage their insurance and self-pay receivables, and Experian Health, the largest data and analytics company in the country.
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