For patients, self-scheduling appointments is convenient. For registrars, it complicates matters somewhat.
“We have inserted ourselves, as much as we can, into that self-service process,” says Michael Sciarabba, CHAM, MPH, director of patient access services at UChicago Medicine.
Hospitals want to fill all available slots and avoid no-shows. Patients want hassle-free appointments. Self-scheduling can help with all that. “The organization’s goal around better, quicker access for patients isn’t going away,” Sciarabba notes.
UChicago was equipped with little patient self-service capability. That changed with the COVID-19 pandemic. Immediate changes were implemented. “If we had more time, we could have automated insurance eligibility coverage screening at self-scheduling,” Sciarabba says.
Ideally, the department would have put in a better insurance entry and screening process. Instead, patients enter health plans by selecting from a list of choices. “Basically, it’s only as good as what the patient puts in. It’s really hard to find a way to have your patient accept the right plan,” Sciarabba explains.
To catch incorrect or out-of-network plans, staff verify coverage as soon as something is scheduled. A few out-of-network cases have gotten through because they appeared to be in-network at the time of scheduling. “We are monitoring it closely,” Sciarabba reports. It has not been a major problem yet, but volumes remain relatively low. “It’s a dissatisfier for the patient, the doctor, and the organization if we don’t follow that up in real time,” Sciarabba says.
Ultimately, the solution is to automate eligibility within the self-service scheduling process. For now, self-scheduling is available just for office visits that do not require authorizations. Things will become far more complicated once patients can schedule procedures for radiology and cardiology. “We will definitely need to build stronger insurance scrubbing procedures at the point of self-service,” Sciarabba adds.
At Loma Linda (CA) University’s Health Access Center, self-scheduling means patients and staff engage in less in-person contact during visits. Most forms already have been signed electronically. The department drew from its existing processes when self-scheduling was implemented on a large scale on short notice.
“Extensive rules and logic were already built into the system. Missing, conflicting, or incorrect registration items fall to a work queue for validation,” reports Ami Shumway, director of operations.
Some appointments are booked by caretakers or family, who did not always have insurance information at the point of scheduling. Sometimes, insurance was verified, but coverage changed before the appointment took place.
Financial services staff work self-scheduled accounts by appointment date, with enough time to reschedule the appointment if needed. “Patients must make appointments a few days out to allow time for verification,” Shumway says.
Staff do their best to identify out-of-network plans. The EMR displays a warning if a plan is not contracted so patients can be notified. Not all out-of-network plans are caught. “We have more than 2,500 plans in our area, and each insurance provider changes their network preferences often,” Shumway says.
Patients are warned that it is possible their plan is out of network. Hopefully, this prompts the patient to double-check with the health plan. “It avoids surprises,” Shumway adds.
At Rochester (NY) Regional Health, self-scheduled appointments are reviewed three days before the visit. Some patients pick the wrong type of appointment, which would not allow enough time on the provider’s schedule. Others pick the wrong type of service. “Staff reach out to help the patient with proper scheduling,” says Gail Bellanca, director of revenue integrity.
Preregistration and good insurance verification tools flag out-of-network plans early enough to do something about it. “We have time to follow up with the patient,” Bellanca adds.