A recent report published 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 healthcare pre-registration. This 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 end up in bad debt write-offs.
Large hospitals can bear the burden of these errors to some extent. However, small hospitals with a gross profit rate of up to 3 to 4 percent cannot absorb the effects of these errors. Irrespective of the margins, every unpaid claim is a blow to a provider bottom line.
Therefore, the one thing that this trend unmistakably points at is that money is made or lost even before care is delivered. So, healthcare 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.
What is Healthcare Pre-registration
Healthcare 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.
Healthcare Pre-registration Prerequisites
Administrative work needs to be completed much in advance of the scheduled appointment. This reduces the chances of errors during face-to-face interactions. A pre-registered patient account is one that has met the below-mentioned criteria at least one day in advance of a scheduled appointment:
- Demographics verified
- Insurance coverage and benefits verified
- Patient intimated about financial responsibility
All providers must make it a point to pre-register as many scheduled visits as possible. As per HFMA’s key performance indicator benchmarks, providers need to carry out the following administrative work.
Demographic Verification
Demographic verification is a primary requirement for healthcare pre-registration. It involves reviewing the social security number and other demographic data such as name, age, sex etc. Validating this data is important because it confirms that the information provided by the patient is genuine and is the same as the one existing in records. Doing this correctly helps hospitals comply with regulatory requirements.
The regulatory rules require hospitals to have the right processes to mitigate patient identity theft. Fraudsters steal health care information to steal benefits meant for other people. Such frauds bleed providers to no end. The Federal Trade Commission (FTC) carried out a survey to find that about 450000 people in the US face identity threats annually, out of which nearly 5 percent are used for stealing medical benefits.
Insurance Verification
Insurance verification is the most important healthcare 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 some of 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 way is to call the payer directly via phone and verify eligibility. This is still in practice today, but is mostly used by small practices and clinics. Large hospitals may not find it easier to verify eligibility with phone calls.
Faxes are an important way to connect with payers. This is a faster and more efficient way. However, it involves lot of manual work and is therefore prone to errors.
Many payers have come up with self-service portals. Hospitals can key in data to fetch reports instantly. This is more efficient way than the above two but is too time consuming and requires staff to shuffle between portals.
Much of the problems posed by self-service portals can be eliminated with the help of vendors offering clearinghouse-style access to patient information directly from the insurer. 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. This speeds up and streamlines the workflow.
The newest and most advanced solution however is automated insurance verification process. This process involves an automated 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 involved by 90%.
Financial Clearance And Up-Front Collections
Upfront collection from patients should always be an integral part of healthcare pre-registration. This will help providers bolt the stable much before the horse escapes. This, however, is an overlooked aspect of healthcare pre-registration which is why most providers have to struggle with recovering money from patients post medical care.
Upfront collection must be done immediately after eligibility verification of patients. Eligibility verification throws up details about patient benefits including co-pay 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 a sort of financial counselling done to avoid future surprises both to the patient and provider. It is particularly helpful for patients who are not aware 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, there are many software solutions available in the market that facilitates the process of 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 healthcare pre-registration process is patient satisfaction. Patients get dissatisfied with waiting times that are too long. This happens when the healthcare pre-registration takes place at the reception. Healthcare 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 Healthcare Pre-Registration
In the new world order revenue cycle management boils downs 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 check. This will assist you flag errors at the initial stages.
You must also provide your staff with the right tools and technologies to discharge their functions. Technologies help to expedite processes like eligibility verification and prior-authorization. Empowering your staff with a rule engine can also be very helpful. It is commonly called as a “claims scrubber,” and helps to carry out edits in keeping with industry standard rules. Likewise. a practice management software can help your front desk staff get instant visibility to co-pays and prior balance accounts.
Who We Are and What Makes Us an Expert?
This article is penned by Outsource RCM, a pioneer in handling back-office support services for healthcare pre-registration and RCM. One of the RCM healthcare processes we specialize in is healthcare pre-registration services. We bank on the best technologies and experienced RCM staff to deliver accurate services to our clients. If you are looking for the best healthcare pre-registration solution, get in touch with us now.
