Ahead of the Patient Financial Services meeting, taking place on November 14th, we had the opportunity to sit down with Michael Brethorst, MS, the Director of Financial Pre-Services at Essentia Health. Read on to hear about his professional background and journey into the healthcare industry, his current priorities at Essentia, and what he’s looking forward to discussing during the upcoming panel.
Tell us about your career journey, and how you came to work in the healthcare industry:
Mike joined Essentia in October 2021, in the midst of the COVID-19 pandemic, and serves as the Director of Financial Pre-Services. Prior to joining Essentia, he was a County Administrator, where he supported the full spectrum of County Services, including Health and Human Services. He was also appointed as a City Administrator and took a special interest in Utility Billing and Emergency Services, before taking on the role of County Administrator.
Mike serviced in the Minnesota Army National Guard, rising to the Rank of Lieutenant Colonel (LTC), and retired after 22 years of service. He has a master’s degree in Public, Human Services, and Health Administration from Minnesota State University, Moorhead, and also earned a bachelor’s degree from St. Cloud State University in Public Administration, with an emphasis on Economic Development. In addition, he is a graduate of the US Army’s Command and General Staff College, Fort Leavenworth, KS.
He has authored more than 100+ articles on a self-published website dedicated to Healthcare and Labor Relations, a tribute to the value he places on learning and growth, which can be found at www.mystaffology.com. As an Adjunct Professor at the University of Minnesota, he also teaches Healthcare Leadership and Policy, Health Care Diversity and Disparities, and Introduction to Healthcare Systems.
His primary focus at Essentia is operational excellence, transparency of processes, and collaborative problem solving to provide the highest patient experience.
Looking ahead to 2024, what are some of your team’s main priorities?
1. Efficient Preregistration: Streamlining the preregistration process should be a top priority to ensure that necessary patient details are recorded accurately and timely. This includes obtaining and verifying patient demographics, insurance information, and clinical data. It eases the registration process on-the-day of service and has a direct impact on patient satisfaction.
2. Authorization Validation: Obtaining the required prior authorizations for different healthcare services is critical to avoid claim denials and disruptions in the healthcare delivery process. Quick validations via direct insurance communication helps ensure faster service provisions, minimizing patient wait times.
3. Financial Clearance: Achieving financial clearance should be prioritized to ensure the patient’s ability to pay and the healthcare providers’ financial sustainability. By assuring insurance eligibility, estimating costs, verifying coverage details, and informing patients about potential out-of-pocket expenses, the department can mitigate financial risks and reassure patients about their financial obligations.
4. Patient Communication: Strong patient communication is crucial in this field. Patients need to fully understand their insurance coverage, out-of-pocket cost, as well as their financial responsibility before receiving services. Clear, jargon-free and empathetic communication can help ease patients’ anxiety around their forthcoming healthcare experience.
5. Regulatory Compliance: Lastly, staying updated with changes in healthcare regulations is vital. Non-compliance can result in financial penalties and potentially harm the healthcare provider’s reputation. Regular training and education sessions for staff members can assist in maintaining up-to-date knowledge on healthcare laws and insurance regulations.
We’re really looking forward to having you participate in our Patient Financial Services meeting on November 14th, where you are joining the panel on the importance of accuracy in registration, and verified eligibility on generating clean claims. What is one area related to the topic that you’re specifically looking forward to discussing with the panelists and audience members?
Verifying Eligibility: Within the healthcare field, this presents several critical advantages, particularly from the perspective of healthcare systems and the people they serve. Here are the key benefits:
1. Efficiency and Speed: Verification of a patient’s insurance eligibility before the delivery of services helps streamline the billing and payment process. It demonstrates upfront whether a patient’s health insurance plan will cover the services, thus speeding up the billing process and preventing delayed payments and revenue loss.
2. Minimization of Denials & Rejections: By ensuring that the patient’s insurance is valid and covers the intended services, eligibility verification can considerably reduce the number of denials and rejections from insurance providers. This can lead to a decrease in costs associated with handling such rejections and ensures a stable income flow for healthcare systems.
3. Better Financial Counseling for Patients: Understanding a patient’s insurance coverage, including out-of-pocket expenses and deductibles, allows healthcare providers to better counsel patients about the potential financial implications of their healthcare services. This can help patients make informed decisions about their care and prepare financially, leading to improved patient satisfaction.
4. Improved Cash Flow: Prompt payment from insurers, stemmed from verifying eligibility, improves cash flow and ensures the sustainability and growth of the healthcare system. It also has implications for resource allocation and the ability to invest in better healthcare facilities.
5. Reduced Instances of Fraud: Verifying eligibility can also help in detecting and reducing fraud. By ensuring that the person receiving care is indeed the insured individual, healthcare systems can mitigate potential risks involved with insurance fraud.
Remember, the goal of eligibility verification is twofold: To ensure healthcare systems can operate efficiently while ensuring patients receive the care they’re entitled to under their insurance coverage. By focusing on these key areas, healthcare systems can enhance their services and fidelity to their mission of providing quality care.
Thank you so much Michael for sharing your knowledge with us!
Make sure to visit Michael’s website for more insights like those he’s shared here:
www.mystaffology.com