New process makes providers happier
New process makes providers happier
Problems fixed before patients arrive
Before a centralized pre-registration department was created at Cambridge (MA) Health Alliance, patients sometimes received unpleasant, unexpected news when they arrived for a scheduled appointment — not about their medical condition, but their insurance coverage.
“In the past, the patient could be evaluated by a provider and receive laboratory tests or X-rays during the visit. After the visit, the claim billed to the insurance company would deny due to seemingly avoidable problems,” says Bettye Sabree, MHA, director of pre-registration and centralized referrals.
In some cases, the visit was denied because the patient’s insurance information was listed incorrectly or the patient did not have the correct primary care provider listed. In other cases, there was no referral in place from the patient’s primary care provider.
“Tensions can arise, with everyone blaming each other for incorrect insurance, subscriber, or demographic information,” says Sabree. To address this problem, patients who call scheduling are now transferred to a centralized preregistration department if they meet any of these criteria:
• self-pay patients;
• patients insured by a plan not contracted with Cambridge Health Alliance;
• new patients;
• patients assigned to a primary care provider outside Cambridge Health Alliance;
• patients whose last pre-registration date is more than 45 days;
• patients injured in an industrial or motor vehicle accident.
If one of the criteria is met, a pop-up in the electronic scheduling system appears and notifies the scheduler to transfer the call to the pre-registration department before confirming the appointment.
“This gives us an opportunity to identify any issues with their insurance before the patient comes in for their appointment,” says Sylvia C. Motta, manager of pre-registration and the call center. “When the patient does present on the appointment day, the patient simply checks in, rather than go through the whole registration process.”
Previously, scheduled appointments sometimes were delayed when patients checked in, and the registration process took some time to complete. “This dissatisfied patients, and it also caused a disruption in the provider’s schedule,” says Motta. “This new system strives to makes sure those issues rarely happen.”
Motta has found that most patients prefer to give their demographic information over the phone. “It is more secure and private, compared with providing this information in a lobby with people in line behind them,” she explains. “Patients also appreciate that when they arrive at other departments, their information is already updated. They don’t have to repeat the process.”
Communication breakdowns
Occasional breakdowns in communication still occur at times with the new process, says Sabree. After calls were transferred, some patients expressed annoyance due to the length of time it took to confirm their demographic and insurance information.
“We found out it was beneficial to let patients know how long the process would take at the beginning of the call,” Sabree says. “We simply tell them, ‘This process is going to take eight to 10 minutes to verify your demographic and insurance information. Do you have 10 minutes to spend to pre-register?’ If the answer is ‘no,’ we ask them to call back at their convenience, as the department is open until 8 p.m. Monday through Thursday and until 5 p.m. Fridays,” she says.
If the scheduler doesn’t transfer the call to pre-registration or the patient hangs up, it becomes a “blame game,” says Sabree. “Preregistration staff says the call wasn’t transferred, and departments complain that the preregistration department didn’t update the patient’s information. This is improving.”
Sources
For more information on implementing a pre-registration program, contact:
• Sylvia C. Motta, Manager, Pre-Registration & Call Center, Cambridge (MA) Health Alliance. Phone: (617) 665-2532. Email: [email protected].
• Bettye Sabree, MHA, Director, Pre-Registration and Centralized Referrals, Cambridge (MA) Health Alliance. Email: [email protected].
Before a centralized pre-registration department was created at Cambridge (MA) Health Alliance, patients sometimes received unpleasant, unexpected news when they arrived for a scheduled appointment not about their medical condition, but their insurance coverage.Subscribe Now for Access
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