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Need a CT scan? Brace yourself for making time-consuming phone calls to schedule it and enduring lengthy waits at registration. Or maybe not. Patient access departments are changing their ways due to rising expectations for on-demand care. Clinics and outpatient service areas at Ochsner Medical Center - North Shore in Slidell, LA, “no longer operate on ‘banker’s hours,’” says Patient Access Manager Tammy Flair.
Instead, appointments are available during extended hours for laboratory and radiology, and Saturdays at outpatient areas.
“We no longer want the after-hour and weekend patients to be processed through with the emergency room patients,” Flair says. Physician clinics have followed suit, offering X-rays, ultrasounds, CT scans, and even MRIs during off-hours so that patients don’t need to go to the hospital for these services.
“Our patient access team has had great success in this process,” Flair reports. The department made several changes to accommodate walk-ins:
• Service areas were expanded by 23 hours per week, with a centralized registration point of entry. “We needed to provide a professional and non-emergent arrival for improved satisfaction,” Flair says.
• Employee schedules were modified to absorb the 23 hours without adding any additional FTEs. “We found the ability to scale the three FTEs in our centralized scheduling department,” Flair explains. Instead of all staff working a 7 a.m. to 5 p.m. shift, a staggered shift was created. One FTE arrives at 12 p.m. to work in centralized scheduling. This employee flips to the front desk from 4:30 p.m. to closing at 8:30 p.m. Lower patient volumes during these evening hours create time for registrars to work on other tasks. These include finishing pre-registration calls and helping patients with wayfinding.
“Scheduling teams are focused on filling the prime spots to serve the waiting patients,” Flair notes.
If the “add-on” patients see Ochsner physicians, it makes things much easier. This is because all the licensure information already is validated and updated in the system.
“But as long as the physician order meets the mandatory requirements, and we confirm their NPI [National Provider Identifier] status, the patients can be served,” Flair says.
• To ensure reimbursement, additional skill sets are required of all patient access employees. All registrars now have access to insurance websites so they can see authorization requirements for each payer. “This information is shared with the physician team to determine medical necessity,” Flair says.
• All frontline staff were trained in scheduling. This expedites patient arrival and registration considerably, making things go much smoother.
“We cannot afford any unnecessary delays waiting on a radiology tech, or the main scheduler to assist,” Flair says.
• Radiology schedules have been modified to fit availability. The schedules have been analyzed and formatted carefully so that the test duration matches the appointment times.
“If there are two techs available for a particular service, such as CT scan vs. mammogram, then two schedules were created,” Flair says.
• A “one-stop shop” has been designed. Now, any point of entry for patient access can complete an arrival. This includes check-in, scheduling, verification, and financial coordination. All team members are cross-trained in the clinics, outpatient departments, the ED, and surgery areas. Now, they can register any patient type.
“Their vast knowledge of insurance benefits and authorization determination allows us to successfully meet the needs of walk-in patients,” Flair explains.
Ochsner’s pre-service team verifies benefits, creates a price estimate, and starts the referral or authorization process.
“This department works these cases as soon as the order is created, or if a patient presents to the facility with an order,” Flair says. These steps occur:
1. The walk-in patient arrives with an order, or the order is faxed over as a “stat,” and is approved;
2. The registration team reviews the schedule and books the appointment, or requests help from centralized scheduling;
3. The insurance card and face sheet are given to the insurance verifier, who starts the process of determining if an authorization is needed;
4. The preservice department educates the patient on their benefits, and provides a price estimate;
5. If authorization is delayed for any reason, then medical necessity is determined by the physician. Payers sometimes require several days to give the authorization, which means it can’t be obtained in time.
In such cases, says Flair, “Our priority is giving the patient the care they need. We take the risk when the physicians confirm medical necessity.” Meanwhile, the team continues working on authorization retroactively to ensure proper reimbursement is obtained. “If authorization is required and pended, calls are made to the physician team for critical clinic notes and confirmation of urgent necessity,” Flair says.
6. If the test isn’t urgently needed and authorization is delayed, it’s scheduled for a future date. Patients are offered after-hour and weekend appointments for convenience. The case is monitored by onsite teams until the authorization gets approved. Throughout the process, the patient is kept updated on the status of things by phone. “It literally is a stop, drop, and roll function to make sure the patient’s needs are met,” Flair adds.