Preregistration has been a hot topic at Baptist Health System in Birmingham, AL, for years, ever since the system transitioned to Epic in 2013. At that point, patient access leaders were discussing various opportunities for improvement across all facilities.
“Utilizing the new system, we had the ability to view more information,” says Wendy Lepp, corporate director of patient access. This paved the way to expand preregistration.
Most importantly, CPT codes were attached to service descriptions in the new system. This gave patient access what they needed to follow up with physician offices and insurance carriers regarding the specific test performed. “Staff looked first at the cases added for the next day. Only when those were finished, did they look at cases further out,” Lepp says.
Two years ago, patient access came up with the idea of preregistering the patient at the time they were scheduled. Early in 2019, the solution was implemented. The biggest worry was how execute the new procedure without adding any staff. In addition to their daily scheduling tasks, registrars also had to preregister patients who were scheduled for future dates.
“Our current process is to pull a schedule for tomorrow and preregister anyone who is still pending,” Lepp says. When that schedule is completed, the staff move on to the next day, and so on. When the appointment is booked, the account routes to a work queue, and a registrar contacts the patient. The new process was piloted at the smallest hospital in the health system first. “It has worked really well there,” Lepp reports. “The staff have taken pride in making it work.”
Next, it was brought to the second largest hospital in the system. Although the preregistration process is new, the department is already seeing benefits:
• There are fewer complaints about surprise out-of-pocket costs. “It’s a patient satisfier,” Lepp says. This is because many people are already worried about costs. Therefore, most appreciate getting some straight talk about what they’re going to owe. If there are any issues, patients are connected with a financial counselor months, weeks, or several days in advance when there is plenty of time to come up with options.
• Fewer procedures need to be rescheduled for financial or coverage reasons. “We identify potential issues earlier, as opposed to just two days in advance,” Lepp says.
Financial counselors and clinical staff in surgical departments work together to resolve insurance issues ahead of time. This means procedures can go as planned. For instance, a financial counselor might inform the clinical area that there is no precertification in place for a patient scheduled for surgery at 5:00 a.m., but that an approval is expected shortly. This allows the procedure to be moved to a different time but still proceed. The patient receives the needed care, does not receive a surprise bill due to a “no auth” denial, and the procedure does not have to be canceled.
• Events progress smoothly on the date of service. All preregistered patients are color-coded in the system (green if all they need to do is sign forms, purple if precertification is needed, and yellow if a copay needs to be collected).
In the past, staff looked first at cases added for the next day. Only when those were finished did they look at cases further out. “We are now starting when the patient actually gets scheduled,” Lepp explains.
Cases are worked right away, regardless of whether the surgery or procedure is scheduled for the following day or months away. “Hopefully, everything will move out a little further,” Lepp says. This gives everyone some wiggle room to address the inevitable problems that arise. Often, the problem is that the doctor’s office never obtained precertification for the surgery. “If there’s enough time to work with, it can hopefully be resolved without the need to reschedule,” Lepp adds.
Although there are many benefits to preregistration, there also are some challenges. For instance, surprisingly often, people’s insurance changes in some way after the initial preregistration call. “If you are working on a case this month, and it’s scheduled for next month, things may change during that time,” Lepp says.
Some patients have Medicare, but it is canceled by the time the procedure happens. Others have had Medicaid coverage, but it switches to an HMO. To catch these changes before claims are sent, a new process was needed. “We have a follow-up work queue that these accounts stay in until we can reverify the coverage during the month of the service,” Lepp explains.
Another challenge is the sometimes-high costs for the patient, even with precertification in place.
“It comes as quite a shock. The concern then becomes: Is the procedure emergent, or can it be done later on?” Lepp says. Early discussions mitigate the stress for the patient, allowing for options such as payment plans to be considered.
Finally, even with enough staff to preregister scheduled patients, there are not always enough resources to follow up on all cases. “That’s been our struggle,” Lepp reports. “We finally got it worked out, I think.” Previously, staff worked by service type; now, they work cases alphabetically. This distributes the workload more equally.
“It has also allowed staff to become more familiar with the insurance requirements for all services, as opposed to specific service types,” Lepp says.