Patient access departments are moving financial discussions earlier in the process with preregistration phone calls.

  • Patients appreciate advance notification of what they’ll owe.
  • On the date of service, preregistered patients are expedited.
  • More efficient workflows made it possible to reallocate a full-time employee for preregistration.

Getting an unexpected bill weeks or even months after a service will frustrate even the most satisfied patient. Preregistration phone calls can prevent this from happening.

“Within my department, I have been able to allocate one dedicated full-time employee (FTE) to call patients and preregister them over the telephone,” says Shelita Russ, CHAM, director of patient access services at Ochsner Medical Center, Kenner; Ochsner Medical Center, River Parishes; and St. Charles Parish Hospital, all in Louisiana. Registrars call patients two or three days before their scheduled services. “The goal is to get out to five days in advance,” says Russ.

The registrar completes the entire registration over the phone. “She also makes the initial request for the patient liability amounts,” says Russ.

The following metrics are being tracked:

  • the number of preregistration calls placed per day;
  • the number of days in advance the preregistration occurs;
  • the amount of payment collected over the phone.

“Because this amount has been minimal, we are beginning to track the point-of-service collections from preregistered accounts made on the actual date of service,” says Russ.

If the patient pays over the phone and wants a receipt, the registrar informs them their printed receipt will be available when they arrive at the facility for their services. If the patient wants to pay in person, the amount they owe is documented in the system so registrars can collect it on the date of service.

Once the registrar completes the pre-registration, she marks the encounter as preregistered. “The front-desk teams can identify the patient and expedite the registration,” says Russ. “We also use the preregistration call to notify patients of any residual balances.”

In the near future, the registrar will set up payment plans as well. “Currently, the preregistration process has not greatly impacted point-of-service collections,” says Russ. Initially, patients were preregistered only if they were having a screening mammogram.

“As we progressed within the pilot, we incorporated the diagnostic mammograms and began requesting patient liability amounts,” says Russ.

Collections have increased, but minimally. Still, patients appreciate being made aware in advance of their liability amounts.

“We expect to see a more notable increase once we incorporate the MRIs and CTs into the preregistration process,” says Russ.

Greater Satisfaction

In the three months since the new preregistration process started, Russ has seen no evidence of poor patient satisfaction. In fact, the opposite is true. “We have found that patients really like the advanced notification of their liability amounts, and also the opportunity to fast track the registration process,” Russ explains.

Patient access chose to pilot the new process in the mammogram area specifically because patient satisfaction scores had dipped in early 2017. “We have seen the standard registration score go from the 37th percentile to the 94th percentile so far,” Russ reports.

Since mammograms are scheduled for every 15 minutes, preregistration has improved patient flow greatly. “It has reduced bottlenecks in the department,” says Russ.

Satisfaction with wait times have increased from the 63rd percentile in the beginning of 2017, to the 99th percentile on the organization’s PressGaney surveys.

The department plans to implement the preregistration process in other diagnostic areas. “We plan to incorporate MRI, CT, and ultrasound patients into the preregistration process,” says Russ.

No additional FTEs were needed for preregistration. “We streamlined a few workflows within the inpatient registration area,” Russ says.

The biggest efficiencies were discovered with the authorization process. Staff were not using the payer portals as expected.

“Once we streamlined that process and staff spent less time on the phone, management was able to incorporate additional tasks into the teams’ day-to-day workflows,” says Russ.

These changes also made it possible for the department to reallocate an FTE for preregistration.

“As we continue to become more efficient in our workflows, we have identified the potential to be able to re-allocate another FTE within the next few months,” says Russ.


  • Shelita Russ, CHAM, Director, Patient Access Services, Ochsner Medical Center — Kenner, Ochsner Medical Center — River Parishes, St. Charles Parish Hospital. Phone: (504) 464-8026. Email: sruss@ochsner.org.