The 3 P's to Perfect Your Pre-Encounter

The Problem

• Double-digit denial rates• Cash flow• Patient billing responsibility

The Opportunity = 3 Ps

Process = Cut denial rates by half(was 10% now 5.7% soon to be 3.0%)

Patient = Better understanding

Payment = Boost cash flow $100k/month

Highlights• Defining the bottom line• Centralization of scheduling: the

key to success• Defining where you are and where

you will go• Develop and deploying a process• Training• Tracking, measuring, and

evaluating the success

The $6 Million QuestionTM

On a scale of 0 to 10, how well do you communicate your patients’ payment responsibility?

John CookWhy should you listen to me?• Served as Revenue Cycle Director for 22 years •Pro Recovery, Inc. = Worked with more than 100+

hospitals on improving their revenue cycle•Reducing AR days from over 100 to 55 days•Advising and mentoring hospital managers•National HFMA Yerger Award for Outstanding

Performance in Education

Lesson #1: Define your bottom line.

•Define why you are implementing a pre-encounter process.•What efficiencies do you want to realize?

Here is what your colleagues said• Consistency• To create efficiencies to promote patient satisfaction and financial accuracy by education patients prior to

service• To educate the patient, financially and clinically• Customer service• Reduce errors / streamline and improve the patient experience• Pre-financial screening• Patient Friendly!!• Financial clearance and education• Get it right the first time• Scheduling• Customer service and collection of money• Obtain authorization• Implement a new program

Source: Answers given by attendees of NCHFMA Roundtable Discussion on Pre-Admission Procedures and Best Practices, July, 2012

Bottom Line: 5 Key Elements1.Cleaner claims2.Patient payment issues3.Communication of

payment expectations4.Asking for payment upfront5.Service excellence

Lesson #2: Centralize Scheduling

• The foundation of a successful pre-encounter process• Scheduling is a patient access

function•One calendar•One location• Everyone on the same page

Lesson #3: Define where you are and where you need to goRate your responses on a scale of 0 to 10, 0 = extremely poor; 10 = extremely well.

• ____ Overall, how would you rate your pre-encounter program?• ____ How would you rate the information you get from patients?• ____ How would you rate your clean claims?• ____ How would you rate your scheduling software?• ____ How would you rate your scheduling process?• ____ How would you rate your insurance eligibility capabilities?• ____ How would you rate your ability to estimate charges?• ____ How would you rate your ability to refer uninsured patients to their

payment options?• ____How would you rate your current collection policies and procedures?

Lesson #4: Develop and Deploy a Process

•Act•Centralize scheduling•Secure technology•Establish a plan and timelines•Complete buy-in

Lesson #5: Train, Inspire, Create

•Create passion•Ask for money•Create service excellence•Communicate expectations

Lesson #6: Track, Measure, and Celebrate the Success

•Reduction in AR days• Increase in clean claims• Increase in point of

service collection• Increase in patient

satisfaction scores

A Successful Process: Cone Health

•High denial rates•Boost cash flow•Training

Results: Cone Health

•Reduction of denials to 5.8% from 10%•Pre-Service collections at $400,000 average of $133,000 per month

Summary Questions

•Where are you in this process?•What is your biggest obstacle?•What are your failures?•What are your successes?

Now ask yourself the $6 Million QuestionTM

If you put in place just a few of these ideas…

How well could you communicate your patients’ payment responsibility?

Quick Start Consultations

Available from John Cook at no cost Contact Informationjcook@prorecoveryinc.com828-773-4466 (Cell)866-907-8023

E Book: The Six Million Dollar Question

How to reduce denial rates, improve patient satisfaction and increase cash flow.

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