Maybe you already have a solid Patient Access process that ensures accurate information is being input into the patient accounting system. If so, that’s great—you’re already acutely aware that small mistakes in Patient Access often lead to larger and harder-to-fix mistakes affecting cash in the business office.
If this is you, you can stop reading.
But if you want to make sure you’re not making the most common Patient Access mistakes we’ve observed with data-driven analytics across more than 80 hospitals, I suggest you keep reading. After all, many hospitals for which we’ve performed our Revenue Cycle Performance Review either claimed they didn’t make the following errors (when data demonstrated they did), or they weren’t aware they were making these mistakes:
- Centralized scheduling. Many hospitals don’t have a system-wide application to coordinate patient scheduling or improve collection of required data. Whether you’re a small hospital or a large healthcare system, you should have a system-wide scheduling application as well as a centralized scheduling department, which is much more efficient than a decentralized, manual, or paper-based scheduling system.
- Required data set. In order to minimize re-work and additional phone calls, it’s important that you have a pre-defined data set within the scheduling system for collection of needed data for each department. The scheduling and/or registration staff should collect all of this data during scheduling. The method of collection is also important. An open-ended question such as “What’s your address?” is better than asking, “Do you still live at 123 Main Street?”
- Medical necessity and ABNs. Your Patient Access team needs to have access to a medical necessity application and check medical necessity during the scheduling process. If ABNs are necessary, these need to be executed during registration as well.
- Financial clearance. You should have a robust financial clearance process in place prior to a scheduled patient’s arrival to verify and validate data, obtain authorizations, ensure medical necessity is checked, verify demographics and insurance, and collect co-pays, deductibles, coinsurance, etc.
- Point-of-service collections. Upfront collections are critical. It’s important you have customer-focused processes, goals, and incentives for your Patient Access staff to ensure that upfront collection goals are being obtained.
Your Patient Access department is a critical component for ensuring the data flowing into your business office is accurate and streamlined for best practice collections and reimbursement. Because many Patient Access employees are entry level or new to healthcare, this department offers a unique opportunity to train them on best practices before bad habits are established. In any event, you’ll be far ahead of many U.S hospitals by implementing these 5 Patient Access guidelines.