This is Part I of a three-part series on maximizing your pre-admissions through effective preregistration and scheduling, prior authorization/pre-certification, and post-contact follow-up. You can read Part II here. Part III can be found here.
Facilitating the success of any pre-admissions process requires that a number of things come together. Let’s look at the structure and the flow of your patients and your internal team. The ideal pre-admission process allows for ease to the patient.
The Pre-Admission Process
- Scheduling. It begins with the physician’s nurse scheduling a procedure for the patient, which needs to be done expediently and should allow for as much time as possible in a non-emergent situation.
- Prior-authorization/Pre-certification. Once scheduled, Prior-authorization/Pre-certification needs to take place with a priority on receiving patient benefits and identifying where the patient is with their benefits.
- Post-contact follow-up. Following the benefits determination, the Financial Counselor and the corresponding nurse will collaborate to contact the patient in the best possible manner. After the Financial Counselor has talked with the patient, they will coordinate with registration to ensure that the financial elements discussed between the patient and the counselor are clear to the registration specialists.
Structuring your pre-admissions process
A centralized location for pre-surgical physicals, discussion of insurance and discussion of financial responsibilities is ideal, our clients have found. A centralized location indicates to the patient your concern for their welfare and a one-stop opportunity to complete everything they need done prior to their procedure.
If funds or management do not see this as an easily accomplished task after considering staffing and budget, then your program must be handled in a documented process to include all the steps discussed in this issue.
The key to a de-centralized pre-admission process is the policies and procedures, which requires a thorough understanding by managers and staff.
Addressing the elephant in the room
Okay, it is time to “raise the bar.” The role of asking patients for money and strengthening the financial position of your facility while always communicating with compassion, dignity and respect is not solely “the business office.” For a pre-admissions system to work, it requires cooperation at all levels of the organization, including the clinical departments.
The clinical side has a tremendous responsibility as it pertains to their relationship with the patient access side. Clearly, the fiscal success of the organization is a responsibility of this department whether they are accepting patients for the clinic or they are scheduling procedures in the hospital. They set the stage for success in both areas.
Responsibilities of clinic “patient access” personnel regarding procedures done at the hospital must include:
- An understanding that must indicate to the patient they will set up a convenient appointment ensuring all aspects of the procedure are identified.
- Prior authorization for the clinic portion of the bill should take place and a satisfactory timeline for “non-emergent cases” should be completed to allow the hospital to do their appropriate pre-admission process.
Additional staff roles at a clinic’s patient access area for your consideration:
- When patients schedule appointments, they should understand that they have co-pays and possibly clinic balances that they will need to pay.
- Always instruct the patient to bring their insurance card.
- Registration staff must collect all co-pays and patient balances when directed by the notes in their system.
- Scripting and role playing is essential to the success of collecting co-pays at time of registration.
- Staff must understand the reason for collecting co-pay.
- Education, consistency, measuring results and celebrating success are essential elements to a successful program.
Continue to Part II here.
Chuck Seviour is vice president of revenue cycle for Array Services Group. Chuck has over 40 years of healthcare industry experience ranging from director of business office operations for a large health system to consulting with more than 150 hospitals as a healthcare consultant for a major accounting firm.