Embed Size (px)
DESCRIPTION
I would like to share with you our concept of Ideal Practice Workflow Plan that results in Increased Revenue and Lowered Cost for the practice. This is truly working with every single consulting assignment we are taking on. Patient engagement for financial purpose begins with the CALL FOR APPOINTMENT and continues thereafter until the claim is paid in full. Let's analyze an ideal practice workflow and steps in engaging the patient effectively not only for clinical reasons but for financial reasons as well. Ideal Practice Workflow Appointment Call Received 1) Workflow begins with Patient Appointments. When a patient calls to make an appointment, certain key parameters are essential to obtain over the PHONE for the success of an efficient workflow management for clinical and financial planning. - Patient's Demographics (Name, Phone numbers, DOB and Gender). The rest of the information such as address, guarantor, work type, job etc. can be obtained when patient arrives in office. - Patient's Insurance Name, Insurance ID for Primary and/or secondary insurances if any. - Patient's Primary Physician if any and reason for visit. The above 3 items are most essential to obtain over the phone in order to determine eligibility of the patient and define a prelim care plan for the patient at the time of service. Back-end Eligibility Verification Team - An accountable team works on verifying all eligibility of patients depending upon his/her reason for the visit. Fast track or basic eligibility can be verified using EHR/PM system however for certain visit types, a practice may require to call an Insurance Company Representative to verify detailed benefits and authorization and/or referral requirements. It is recommended to have DETAILED TELEPHONE verification for all NEW PATIENTS. For returning or existing patients, the practice may use ONLINE/EHR system. - Depending upon eligibility verification, back-end eligibility team creates a financial plan and/or patient responsibility and communicates to FRONT OFFICE team for further action. Patient Check-in Process and check-out person (Front Desk) -Verifies the date & time of last office visit. -Makes sure that Demographic Information is up to date including email/cell. -Activates Patient portal and provides a brief video tutorials through email. -Addresses any system Alerts for Financial/Insurance Issues. -Collects patient balances due to co-Insurance/Co-pay (OR) Deductible -Completes Appointment Scheduling upon patient’s check-out -Clarifies, if patient was ordered an outside Test/Procedure/Referral, was the referral or authorization obtained for convenience of the patient? Patient Engagement by Clinical Assistants such as Nurses/MA -Validates primary reason for visit. -Establisesh Detailed History (this would save major time of the physicians before they enter in exam rooms) - Generates Medication Reconciliation to confirm current meds taken by patient.
Citation preview
Ideal Practice WorkflowRevenue Maximization and Cost Efficiency
Contact us :2222 Morris Ave. 2nd Floor,Union, NJ-07083Ph: (908)-384-1608Email: [email protected]
About UsClinicspectrum is a healthcare services company providing outsourcing/back office and technology solutions for 17+ medical billing companies, 600+ medical groups/healthcare facilities including hospitals, and hospital medical records departments .
Ideal Practice WorkflowPatient engagement for financial purposes begins with the CALL FOR APPOINTMENT and continues thereafter until the claim is paid in full. Let's analyze an ideal practice workflow and steps in engaging the patient effectively not only for clinical reasons but for financial reasons as well.
Patient Front Desk Process
Back-End Eligibility Verification Team.
Appointment Call Received
Back-Office/Billing Team
Physician’s Workflow
Patient Engagement by Clinical Assistants
Operation Team
Clinical Reminder Team
Appointment Call ReceivedWhen a patient calls to make an appointment, certain key parameters are essential to obtain over the PHONE for the success
of an efficient workflow management for clinical and financial planning.
Phone NumberPatient’s phone number is noted for future reference
GenderPatient’s gender is recorded.
Date of BirthPatient’s date of birth is noted.
Patient’s NamePatient’s Insurance name is noted down.
Eligibility Determination ParametersThe below 3 parameters are most essential to obtain over the phone in order to determine eligibility of the patient and define
a prelim care plan for the patient at the time of service
Patient’s Primary PhysicianPatient’s primary physician if any and reason for visit.
Patient’s Insurance Name
Patient’s name which has been recorded with the
insurance.
Insurance IDPatient’s insurance ID is
recorded.
Back-end Eligibility Verification TeamAccountable team members work on the back-end to verify all of the eligibility information of the patient depending on his/her visit depending on the visit reason. Depending on the eligibility findings, a team member creates a financial plan
and/or patient’s responsibility and communicates with FRONT DESK for further process.
EHREHR/PM SystemTo fast track or for basic eligibility Electronic Health Record/ Practice Management systems are used to verify detailed benefits and authorizations and/or referral requirements.
Detailed Telephonic ConversationThis practice may require a call to the Insurance Company Representative to verify details and benefits . This method of verification is highly recommended for Detailed Telephonic conversation for all new patients.
Patient Front Desk ProcessFollowing steps are taken to complete Patient’s Check-in and Check-out process:
Addresses any system Alerts for Financial/Insurance Issues
Verifies last date & time of last office visit
Completes Appointment Scheduling upon patient’s check-out
Check if referral or authorization obtained is
convenient for patient
Collects patient balances due to co-Insurance/Co-pay (OR) Deductible
Activates Patient portal and provides a brief video tutorials through email.
Clarifies, if patient was ordered an outside
Test/Procedure/Referral
Verifies demographic information till date including email id & cell.
Patient Engagement by Clinical AssistantsWith the below workflow plan, physicians will save time and are able to walk-in an exam room, review information and
decide whether tests/procedures completed by their clinical assistant team were truly necessary.
Review Preventive
Tests & Previous
Treatments
Validates Primary Visit
Establishes History
Generates Medication
Reconciliation
Makes List Of Procedures To Be Performed
Reviews Clinical
Protocols
Distributes Questionnaire For Diagnostic
Tests
Documents Allergies &
Current Vitals
Benefits of Clinical Assistants
Time SavingPhysicians have to just walk-in, review information & decide whether tests/procedures completed by their clinical assistant team were truly necessary
Care Plan Management
This workflow removes the gaps and improves risk management
Accountable Care
Allows the clinical team to truly follow Clinical Guidelines to take care of patients
Physician’s WorkflowThis is the workflow of Physicians which makes medical processes complete fast and efficient.
Review history, allergy, reason of visit &
completed tests based on clinical protocols
Review
Performs physical tests, order additional lab
work & diagnostic tests or referrals.
Examination
Completes electronic chart using DRAGON or
outside Medical Transcription Services.
Completion
Spends less time in chart completion &
MORE time in patient’s CARE
Care
Back-Office/Billing Team
Physician sends completed chart and the information for billing and is transferred through Electronic Superbill / Paper Superbill or Autogenerated Claims through an EHR to the billing team.
Billing team at the Medical Practice submits claims daily in order to forecast daily/weekly cash flow. They maintain a 4 day gap from date of service providing enough time for physicians to finish charts, however the cycle of billing must be kept intact.
AuditingMonthly Audit team performing audit on OUTSTANDING Primary claims and creating an action plan for follow up. important to follow up on OUTSTANDING claims once in 6 weeks for optimum cash flow.
Com
mun
icatin
g
Com
mun
icate
with
pati
ents'
for h
igh
dedu
ctibl
e / c
oord
inati
on o
f ben
efits
/ clin
ical
ques
tionn
aire
sent
by h
ealth
plan
s.
Man
agin
g D
enia
lsW
ork
on D
enia
ls w
ithin
72
hour
s &
kee
p th
em in
que
ue fo
r fol
low
up
in 6
-7 w
eeks
.
Posting
Post daily payments and bill balances to secondary or patients. Don't wait fo
r
sending statements at the end of the month, daily closing require all actions
associated with it
Submission
Submit claim
s daily fo
r at le
ast 1 day of se
rvice m
inimum (th
ere
could be gap of few days fr
om time of service
).
Billing Team
Operation Team
Identify use of Technology/Outsourcing
Cost Reduction Plans Discussed
Monthly meetings are conducted to find available options to reduce operational costs through Automation or Outsourcing Services.
Clinical Reminder TeamMain role is to do DATA MINING from EHR/Billing System to identify patients for Horizontal Growth as well as required visits in office. They send reminder to patient with the following methods:
SMS
Automated calls/Live Representative calls
Patient Portal
Operation Team
Clinical Reminder Team would also be responsible for Medication Adherence and compliance for outside tests/referrals for patients.
This workflow plan takes a practice to next level in REVENUE / COST / RISK Management and make them truly accountable in care.
REVENUE
RISK
COST
Contact Us
2222 Morris Ave. 2nd Floor,Union, NJ-07083
Websitehttp://
clinicspectrum.com/
Phone Number908.834.1608
omClinicspectrum is a healthcare services company providing outsourcing and back office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments.
