The 3 P's to Perfect Your Pre-EncounterVA/DC HFMA March, 2015

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

The Opportunity = 3 Ps

In our Process With our Patient Boosting our Payment

Pre-Encounter

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?

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 Elements

1.Cleaner claims

2.Patient payment issues

3.Communication of payment expectations

4.Asking for payment upfront

5.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 go

Rate 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

Denial Rates Cash Flow An all new process

Results

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? 

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

How well could you communicate your patients’ payment responsibility?

John Cook

Contact Information

jcook@prorecoveryinc.com

828-773-4466 (Cell)

866-907-8023

E Book: The Six Million Dollar Question

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