Patient Access Services

At the Wilshire Group, one of our primary goals is maximizing value and mitigating risk in your revenue cycle. Achieving that goal begins with optimized and aligned front-end operations, processes, and technology. Whether it be centralizing functions, aligning workflow to best practice, adopting new technologies, implementing reporting and accountability structures, or any other strategic initiative, the Wilshire Group has the people, approach, and experience to help you drive change at your organization.

Services and Approach

The Wilshire Group is dedicated to a business and support model that will yield lasting results for your organizational initiatives.  We employ cost-effective methodologies, leveraging some of the brightest minds and most impressive people you will encounter, in order to help your programs reach their maximum potential.  We know that you set the bar high for your organization and staff, but achieving the outcomes you seek isn’t always straightforward.  Our assessments, collaborative approach, and prowess for fine-tuned project management and delivery can get you there. We pride ourselves on partnering with organizations large and small to set and accomplish goals, reach new heights, and push the boundaries of what is possible in healthcare.

We offer many solutions to improve your patient access suite ranging from focused optimization projects to large transformations. We perform assessments, develop and execute on project plans and support you in achieving your operational goals. We work with you to clearly define goals and benchmark the metrics related to that work. We don’t just deliver the work, we help you measure its impact and value. Below are some of our primary areas of focus:

  • Registration Process Improvement – Streamline your revenue cycle with efficient, intuitive front-end process
  • Real Time Eligibility – Automate real time eligibility to improve accuracy and reduce manual process
  • Front End Payment Collection – File your benefits data automatically and increase your collections
  • Authorizations and Referral Patterns – Develop and end-to-end process for Referrals while analyzing how referrals enter and exit your system
  • Patient Self-Service Functions – Empower your patients by developing online scheduling and registration processes
  • Operational Transformation – Align to best practice and improve staffing models to increase overall efficiency
  • Scheduling Accuracy and Utilization – Maximize provider utilization and increase accessibility for your patients

To learn more about what we may be able to help you achieve, or to express interest in a plan tailored to your needs, contact f.jenkins@thewilshiregroup.net and m.perron@thewilshiregroup.net.

Detailed Service Offerings

An efficient revenue cycle begins with optimized and aligned front-end operations and processes. Whether it be centralizing functions, aligning workflow to best practice, implementing reporting and accountability structures, or any other strategic initiative, the Wilshire Group has the experience to help you drive change at your organization. Our focus is a complete revenue cycle improvement and that begins with optimizing patient access workflows.

What impact you can make with Wilshire:

  • Improve productivity 
  • Increase accountability 
  • Promote transparency 
  • Decrease error and risk 
  • Reduce costs 

How you can work with Wilshire to get there: 

  • Transformation Strategy – Having a strategic plan for your future state patient access operations is central to aligning to best practices, increasing efficiency and reducing risk. 
    • Deliverable – Develop a strategic roadmap of operational and IT enhancements to achieve your goals. 
    • Value Drivers – Efficient investment, reduced risk, increased ROI 
  • Functional Centralization – As technology continues to improve, centralizing front end revenue cycle functions is becoming more attractive model for many organizations. The change can be very targeted by geography or function or organization wide. 
    • Deliverable – Assess areas for centralization value, plan implementation, and deliver operational and IT changes. 
    • Value drivers – Reduced cost, increased efficiency, a better patient experience 
  • Reporting and Accountability Structure – One of the most powerful things you can do in any part of the revenue cycle is create effective and sustainable reporting and accountability structures. Work with us to make sure you have the right, actionable data in the hands of the right leaders to manage and drive change. 
    • Deliverable – Reporting and management assessment, report and workflow development, future state report and management road map and implementation. 
    • Value Drivers – Increased accountability, increased productivity, sustainability and continuous improvement 
  • Front End Alerts and Workqueues – To maximize ease of use, there should be consistency between what end users are alerted for on the front end and what they are required to follow up on via workqueues. By doing so, you increase accountability as well as the effectiveness of front end warnings. By fixings items early in the revenue cycle, you will reduce issues downstream. 
    • Deliverable – Align the required items in registration with what is required to successfully bill a patient. 
    • Value Drivers – Reduced claim edit volume, reduced denials, improved registration efficiency and productivity 
  • Registration Claim Edit Ownership – Registration related claim edits are often best worked by the group of users that created them. Again, ownership of these will increase accountability in front-end staff. 
    • Deliverable – Complete IT and operational changes necessary to map edit ownership to agreed up groups and individuals. 
    • Value Drivers – Increased accountability and productivity, increased clean claim rates 
  • Front End Specialty Billing Processes – Many specialty billing scenarios like transplant or worker’s compensation, require front processes to be successful. It is critical to design efficient, automated front end workflows so that these patients can be billed effectively.   
    • Deliverable – Develop front end operational workflow and corresponding IT changes to support complex billing scenarios. 
    • Value Drivers – Reduced denials, increased clean claims 

The Wilshire Group can analyze your real time eligibility (RTE) processes to ensure efficient workflows. Many errors in the revenue cycle can be attributed to not selecting the appropriate insurance plan during registration or not receiving all the appropriate benefits information. With our experience, we review current RTE workflows and develop ways to automate processes like insurance selection and benefits filing. We can also assist in vendor selection and analysis. 

What impact you can make with Wilshire: 

  • Increased RTE Automation 
  • Decreased Eligibility Related Errors and Denials 
  • Increased Front End Payment Collection 
  • Optimized RTE Processes 

How you can work with Wilshire to get there: 

  • Optimization Plan – Having a strategic plan for your Real Time Eligibility process is central to aligning to best practices, increasing efficiency and decreasing denials. 
    • Deliverable – Develop a strategic roadmap of operational and IT enhancements to achieve your goals. 
    • Value Drivers – Efficient investment, reduced risk, increased ROI 
  • Benefits filing and Payment Collection – Filing benefits information is instrumental in calculating accurate estimates and collecting payments on the front end. Most RTE vendors will offer a service that standardizes benefit data returned in the response to facilitate the set up for filing this information.
    • Deliverable- File benefits information that is calculated for estimates and develop a process to improve front end payment collection 
    • Value Drivers – Increased front end payment collection, decreased manual work 
  • Plan mapping and Auto-Creation of Insurance Plans – Selecting the correct insurance plan is a critical initial step in the revenue cycle. You can configure Epic to automatically recommend the correct insurance plan based on information returned in the response so that end users don’t need to choose from a list. You can also automatically create the coverage which requires no end user intervention. 
    • Deliverable – Develop a strategy for plan mapping at least 80% of your volume, especially focusing on Medicaid and Medicare Replacement Plans 
    • Value Drivers – Workflow automation, decreased denials and underpayments from incorrect registration 
  • Self pay process – Most eligibility vendors will offer a service to scrub self pay patients and try to find Medicaid or commercial insurance. Its important to develop a comprehensive process for when to scrub this patient population to maximize efficiency and reduce RTE vendor costs. 
    • Deliverable – Develop self pay processes to reduce overall self pay volumes 
    • Value Drivers – decreased self-pay volumes, streamlined financial assistance process 

Referral and Authorization workflow is vital to the financial health of your organization. They determine can determine if, how, and when patients are seen for services, and if you are reimbursed for those services. This has historically been a challenging area to manage and optimize effectively. However, thanks to advances in technology and best practice operational models, there are significant opportunities to improve efficiency and reduce risks. 

What impact you can make with Wilshire: 

  • Reduce authorization related denials 
  • Understand and control referral leakage 
  • Create reporting capabilities and accountability structures for continuous improvement 
  • Align your operating model to industry best practice 
  • Ensure you are utilizing the latest technology 

How you can work with Wilshire to get there: 

  • Referral and Authorization Strategy – Having a strategic plan for your referral and authorization operations is central to aligning to best practices, increasing efficiency and reducing risk. 
    • Deliverable – Develop a strategic roadmap of operational and IT enhancements to achieve your goals. 
    • Value Drivers – Efficient investment, reduced risk, increased ROI 
  • Referral Generation – Automating referral generation is an important step in the referral process. Taking information entered by the physician decreases manual intervention and improves time to get referrals routed to the appropriate staff. If you are utilizing automated authorization products, automated referral generation can initiate the request for approval. 
    • Deliverable – Develop an ordering process that automatically creates referrals with enough information to route them to the appropriate staff. 
    • Value Drivers – Increased referral capture rate, lesser, reduced denials, reporting capabilities 
  • Authorization Requirement Analysis – To further streamline the referral process, it is important to analyze what procedures requires authorization by payer so that end users can focus on those referrals that require follow up by the payer.  
    • Deliverable – Identify groups of services that don’t require authorization and configure system to process them electronically. 
    • Value Drivers – Increased referral throughput, staff focused on the right work, reporting capabilities 
  • Referral Accountability Structure – Develop a process from order initiation all the way through authorization and the subsequent referral visit so that ownership and communication is clear through all points. This includes workqueue review, standardized referral templates, management consulting, reporting, letters and other processes. 
    • Deliverable – Streamline the workflow process so ownership is clear at all points in the life cycle of a referral. Implement reporting capabilities and management structure to drive improvement and compliance. 
    • Value Drivers – Increased accountability, transparency, and productivity,  
  • Referral Pattern and Leakage Analysis – Use your Epic and payer data to identify root cause and mitigate referral leakage at your organization. 
    • Deliverable – Reporting, operational, and IT enhancements to help identify and control leakage. 
    • Value Drivers – Increased referral capture, insights into physician and patient behavior, improved patient experience 
  • Denials and Follow Up Analysis – Develop a process for end users to manage referrals that are not authorized by the payer. By creating exception-based workflows, your staff can focus only on the referrals that require manual intervention. 
    • Deliverable – Create exceptions-based processes for authorization denials. 
    • Value Drivers – Increased denial productivity, staff focused on the right work, reporting capabilities 
  • Authorization Product Strategy and Implementation – Many vendors offer services to connect to payers electronically utilizing the ANSI 278R interface. This interface can automate the inquiry and submission processes for a referral and some vendors will also offer automation for determining what requires a referral. 
    • Deliverables – Use additional technology to automate other pieces of the referral process 
    • Value Drivers – High

To learn more about these packages and what we can help you achieve, contact f.jenkins@thewilshiregroup.net and m.perron@thewilshiregroup.net

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