Use the following self-assessment tool to ensure that you have key processes covered ("yes" is the preferred response for each process). Then, check your performance measures against the better-practice target levels in the performance indicator section.

Preregistration and Preauthorization

 

Key Processes  

Yes  

No  

Follow-up Action  

1. Have a unit dedicated to preregistration and preauthorization.

                           

 

 

2. Processes and information systems are integrated between scheduling and preregistration.

 

 

 

3. Services are postponed if not preauthorized in advance.

 

 

 

4. Financial counseling is a part of the preregistration and preauthorization process.

 

 

 

  • Patient balances and payment obligations are discussed with the patient.
 

 

 

 

  • The hospital's policy for point-of-service payment explained to the patient.
 

 

 

 

  • The patient is reminded to bring required payment and insurance cards.
 

 

 

 

Key Performance Indicators  

Target  

Actual  

Follow-up Actions  

1. Overall pre-registration rate of scheduled patients

≥95%

 

 

2. Overall insurance verification rate of pre-registered patients

≥ 95%

 

 

3. Deposit request rate for co-pays and deductibles

≥ 95%

 

 

4. Deposit request rate for elective admissions or procedures

≥ 95%

 

 

5. Deposit request rate for prior unpaid balances

≥ 95%

 

 

6. Data quality compared to pre-established department standards

≥ 98%

 

 



This checklist was based on HFMA's February 2004 audio web cast, "Developing Key Performance Indicators for the Revenue Cycle," by David Hammer, Vice President, Revenue Cycle Management Services, McKesson Information Solutions, and Roland Funsten, Assistant Vice President, Revenue Cycle Operations, St. Vincent Hospital. Questions or comments may be directed to david.hammer@mckesson.com  or rsfunste@stvincent.org.  

Publication Date: Thursday, April 01, 2004