Why Pre-Registration Should Be the Cornerstone of Your Revenue Cycle Management Process

A recent report by the Healthcare Financial Management Association (HFMA) states that rework in medical revenue cycle management takes up nearly 80% of hospital billing office time. Much of these reworks happen due to errors and oversight on the front end during Patient pre registration, which causes the back-end work to pile up. The fallout of such reworks is increased delays, denials, a rise in A/R days, and rejected claims that usually result in bad debt write-offs.

In some instances, larger healthcare providers might bear the burden of these errors. However, mid and small healthcare providers with a marginal gross profit cannot absorb the economic implications of these errors. Irrespective of the margins, every unpaid claim blows a provider’s bottom line.

Therefore, this trend unmistakably points out that money lost after the healthcare service is delivered. Patient pre registration should be the cornerstone of RCM healthcare, and hospitals must improve their front-end administrative work to set things right from the onset. 

Understanding the Patient Pre Registration

Patient pre registration is the first encounter with a patient beyond. The process needs to be efficient and accurate to ensure uninterrupted revenue earnings. This stage of patient interaction must be fully utilized to understand and clear all the cobwebs related to financial transactions. Therefore, your front-end staff must be fully prepared to help you get a clear picture on payer reimbursements, collect patient payments, and convey out-of-pocket expenses to patients in unequivocal terms. 

Efficient and accurate patient pre registration is key to ensuring smooth revenue flow and patient satisfaction. Here’s why:

1. Transparency in Financial Transactions: Reimbursements to Payers: Clarifying what the insurance will cover in advance can greatly avoid billing problems later on. For instance, knowing the ins and outs of payer reimbursements upfront guarantees that the patient and the practitioner agree on the expenditures that are covered. 
2. Patient Payments: By collecting payments from patients at the time of patient pre registration, healthcare facilities can lower the quantity of uncollected income. A research conducted by the Medical Group Management Association found that practices that receive payment in advance of services have a thirty percent increase in collection rates. 
3. Out-of-Pocket Expenses: Keeping the patient informed about out-of-pocket costs helps prevent financial shock. Increased patient satisfaction and confidence can result from this transparency.

Prerequisites for Patient Pre Registration

There are numerous administrative duties that need to be competently completed behind the scenes in a healthcare center before patients enter. These duties reduce the possibility of mistakes during in-person interactions while also streamlining the patient experience. The first stage in the healthcare procedure that guarantees everything is in order before the patient even arrives for their visit is patient pre registration.

Prerequisites for patient pre registration include a checklist that needs to be completed at least one day prior to the planned appointment. Let’s dissect what this means:

1. Patient Verification: Verifying the patient’s demographics entails validating important details such as name, address, phone number, and insurance information. Here, precision is essential to guarantee smooth billing and communication procedures.
2. Medical Insurance Verification: In order to appropriately assess the patient’s financial responsibilities, healthcare practitioners must confirm the patient’s insurance status and benefits. By taking this action, payment commitment ambiguities and surprises are reduced.
3. Notification of Financial Responsibilities to Patients: Patients must be made fully aware of their financial obligations well in advance. This covers any deductibles, copayments, or treatments that your insurance does not cover. In this way, open and honest communication between the patient and the practitioner promotes trust.

These actions improve patient experiences while also increasing operational efficiency. The Healthcare Financial Management Association (HFMA) has established industry benchmarks that underscore the need of providers pre-registering for a maximum number of scheduled visits. This aligns with the overarching objective of healthcare administration’s optimization of key performance indicators.

Healthcare institutions can reduce administrative errors, increase billing accuracy, and ultimately provide better patient care by following patient pre registration practices. It’s an unseen work that prepares the groundwork for efficient and effective healthcare delivery.

Demographic Verification

Consider demographic verification as the medical equivalent of verifying your passport one last time before boarding a plane. Ensuring that the information provided corresponds with what is already on file is an important element in the pre-registration process for patients. Here’s a closer look at the significance of it:

1.  Examining Crucial Information: This method collects every piece of information, including social security numbers and fundamental data like name, age, and sex. It is analogous to verifying your identification prior to being allowed entry into an ultra-secret club, only in this instance, the club consists of your medical billing information.
2. Verifying Genuineness: Hospitals must make sure that the data submitted by patients is authentic, just as you wouldn’t want a fake concert ticket. Checking demographics makes sure that everyone is in agreement and helps to identify any inconsistencies.
3. Observance of Regulations: Demographic verification is covered in detail in a handbook devoted to patient information protection. In order to ensure patient privacy and security, hospitals must adhere to legislative regulations, making sure all the necessary steps are taken.

Now, let’s talk about the not-so-fun part – identity theft. It’s like someone trying to sneak into the VIP section of a party using a fake ID, except instead of free drinks, they’re after medical benefits. Here’s where things get serious:

1. Theft Threats: Fraudsters are always on the prowl, looking to swipe healthcare information like a thief in the night. According to the Federal Trade Commission (FTC), around 450,000 people in the US fall victim to identity theft each year. And guess what? Nearly 5% of those cases involve crooks trying to score medical benefits meant for someone else.  
2. Provider Pain: Not only does identity theft cause patients to suffer, but it also causes healthcare practitioners to suffer. With each fraudulent transaction, their resources are depleted more quickly than a leaking faucet. It’s exasperating and never-ending, like attempting to fill a bucket with holes in it.

By mastering demographic verification, foiling identity fraudsters, and protecting patient data, hospitals can stay ahead of the curve. One verification at a time, it’s not just about checking boxes; it’s about protecting the integrity of the healthcare system.

Medical Insurance Verification 

Medical Insurance verification is the most critical patient pre registration activity. After a patient seeks an appointment, the provider must verify facts with the insurance provider. They need to verify the following:

• Verify that the patient is enrolled and the plan is as furnished 
• Confirm deductibles, co-pays, and co-insurance 
• Enquire about any referrals / pre-authorizations 
• Find out about secondary coverage such as Medicare/Medicaid 

 The above-mentioned list is one of the benchmarks established by HFMA to collect information about patients. Hospitals and providers need to carry this out in efficient and accurate ways. There are various ways to do this. 

 One age-old method is to call the payer directly to verify eligibility. This is still in practice today, but it is mostly used by small practices and clinics. Large hospitals may find it challenging to verify eligibility with phone calls. 

Faxes are an important way to connect with payers. They are faster and more efficient. However, they involve a lot of manual work and are, therefore, prone to errors. 

Many payers have developed self-service portals. Hospitals can key in data to fetch reports instantly. This method is more efficient than the above two, but it is too time-consuming and requires staff to shuffle between portals.  

Vendors offering clearinghouse-style access to patient information directly from the insurer can help eliminate many of the problems posed by self-service portals. However, this method of eligibility verification can be very efficient only if the vendor is connected to all major payers.   

Integrated solutions from third-party intermediaries have also been very useful to providers. These solutions work hand-in-hand with Health Information Systems and post-fetched information directly into patient records, speeding up and streamlining the workflow. 

However, the newest and most advanced solution is an automated medical insurance verification process. This process involves a computerized tool that is built on pre-defined algorithms to fetch information from payer database. It is the most efficient way so far because it cuts down on time and costs by 90%. 

Financial Clearance And Up-Front Collections

Upfront collection from patients should always be an integral part of Patient pre registration. This will help providers bolt the stable much before the horse escapes. However, this is an overlooked aspect of Patient pre registration, which is why most providers struggle with recovering money from patients after medical care.

Upfront collection must be done immediately after patients’ eligibility verification. Eligibility verification throws up details about patient benefits, including co-pays and deductibles. After getting verified from the payer, the provider must let the patient know upfront about their part of the payment or out-of-pocket. This is financial counseling done to avoid future surprises both to the patient and provider. It is particularly helpful for patients unaware of their insurance coverage. Such patients appreciate being intimated about their liability in advance.

Upfront collection is challenging because it mostly relies on homegrown processes, most of which are manual. Nowadays, many software solutions are available in the market that facilitate upfront collection. These solutions produce accurate and quick out-of-pocket estimates by merging patient coverage benefits, payer contracted rates, and hospital chargemaster data.

Patient Satisfaction – A Collateral Benefit

A collateral benefit of a robust Patient pre registration process is patient satisfaction. Patients get dissatisfied with shorter waiting times. This happens when the Patient pre registration takes place at the reception. Patient pre registration also ensures that the patient moves quickly through the front door and into the right healthcare departments. This creates an overall satisfactory experience. The experience spurs them to clear their out-of-pockets upfront.

How to Streamline Patient pre registration

In the new world order, healthcare revenue cycle management boils down to front desk management. Therefore, your first focus must be to train your front-end staff adequately and continuously. The best option is to have a multi-tiered front-end task handler. You can dedicate one of the tiers to quality checks. This will assist you in flagging errors at the initial stages.

You must also give your staff the right tools and technologies to discharge their functions. Technologies help expedite processes like eligibility verification and prior authorization. Empowering your staff with a rule engine can also be very helpful. It is commonly called a “claims scrubber” and helps to carry out edits in keeping with industry-standard rules. Likewise, practice management software can help your front desk staff get instant visibility to co-pays and prior balance accounts. 

What Makes OutsourceRCM Expert in Patient Pre Registration

At OutsourceRCM, we’re not just another player in the game – we’re pioneers of back-office support services, especially when it comes to patient pre registration and revenue cycle management (RCM). Patient pre registration is our bread and butter, and we’ve honed our expertise over years of dedicated service in the healthcare industry.

What sets us apart? It’s simple: We combine cutting-edge technology with a team of seasoned RCM professionals who know the ins and outs of patient pre registration like the back of their hand. With us, accuracy isn’t just a goal, it’s a guarantee.

If you’re looking for the ultimate patient pre registration solution, look no further. Contact us today, and let’s revolutionize your healthcare administrative processes together.