April 7, 2004
Sound pre-encounter processes are essential to effective revenue cycle management --especially in the current environment of scrutiny over the treatment of uninsured or underinsured patients.
The following self-assessment is an excerpt from a new tool in the HFMA Resource Center addressing scheduling, preregistration and preauthorization, and insurance verification. It is the first in a series of tools based on HFMA's popular February 2004 audio web cast, "Developing Key Performance Indicators for the Revenue Cycle." Use it to ensure that you have key processes covered ("yes" is the preferred response for each process). Then, check your performance against the better-practice target levels in the performance indicator section.
Scheduling |
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Key processes |
Yes |
No |
Follow-up actions |
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1. Use single on-line scheduling software enterprise-wide. |
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2. Have a unit dedicated to central scheduling.
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3. The central scheduling unit answers to the Chief Revenue Officer. |
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4. Surgery uses the same scheduling software as other departments. |
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5. The scheduling system interfaces with the registration system. |
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6. Use an on-line outpatient medical necessity system before service is provided. |
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7. Precertification requirements are shared with referring physicians' offices. |
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8. Physicians' offices are able to make on-line appointment requests. |
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9. Nonemergency services are scheduled 12 or more hours in advance. |
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10. Processes and information systems are integrated between scheduling and preregistration. |
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11. Services are postponed if not preauthorized in advance. |
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· Patient balances and payment obligations are discussed with the patient. |
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· The hospital's policy for point-of-service payment is explained to the patient. |
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· The patient is reminded to bring required payment and insurance cards. |
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Key performance indicators |
Target |
Actual |
Follow-up actions |
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1. Overall scheduling rate of potentially-
eligible patients |
100% |
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· Scheduling rate for elective and urgent inpatients |
100% |
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· Scheduling rate for ambulatory surgery patients |
100% |
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· Scheduling rate for high-dollar outpatient diagnostic patients |
100% |
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2. Scheduled patients' preregistration
rate |
≥ 95% |
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SOURCE:
"Self-Assessment Tool: Scheduling, Preregistration and Preauthorization, and Insurance Verification," by David Hammer, Vice President, Revenue Cycle Management Services, McKesson Information Solutions, and Roland Funsten, Assistant Vice President, Revenue Cycle Operations, St. Vincent Hospital.
Additional Resources
- Back to Basics: A Self-Help Approach to Achieving Financial Success
- PFS Forum Job Description Library-pre-encounter positions
- Browse all HFMA's revenue cycle offerings
- Browse all HFMA's uninsured offerings
If you have questions or comments about HFMA Wants You to Know, contact editor Laura Noble at lnoble@hfma.org.
HFMA Wants You to Know ISSN: 1540-0697. Volume III, Issue 8. Copyright 2004, Healthcare Financial Management Association. All rights reserved.