Workflow Plan for Practice Management - Increase Revenue and

1. Ideal Practice Workflow Revenue Maximization and Cost Efficiency Contact us : 2222 Morris Ave. 2nd Floor, Union, NJ-07083 Ph: (908)-384-1608 Email: info@clinicspectrum.com

2. About Us Clinicspectrumis a healthcare services company providing outsourcing/back office and technology solutions for 17+ medical billing companies, 600+ medical groups/healthcare facilities including hospitals, and hospital medical records departments. 

3. Ideal Practice Workflow Patient engagement for financial purpose begins with the CALL FOR APPOINTMENT and continues thereafter until the claim is paid in full. Let's analyze an ideal practice workflow and steps in engaging the patient effectively not only for clinical reasons but for financial reasons as well. Appointment call received Physician’s Workflow Back-end eligibility verification team . Back-office/Billing Team Operation Team Patient Front Desk Process Patient Engagement by Clinical Assistants Clinical Reminder Team

4. Appointment Call Received When a patient calls to make an appointment, certain key parameters are essential to obtain over the PHONE for the success of an efficient workflow management for clinical and financial planning. Date of Birth Patient’s date of birth is noted. Patient’s Name Patient’s Insurance name is noted down. Phone Number Patient’s phone number is noted for future reference Gender Patient’s gender is recorded.

5. Eligibility Determination Parameters The below 3 parameters are most essential to obtain over the phone in order to determine eligibility of the patient and define a prelim care plan for the patient at the time of service Patient’s Insurance Name Patient’s name that has been recorded in the insurance. Patient’s Primary Physician Patient’s primary physician if any and reason for visit. Insurance ID Patient’s insurance ID is recorded.

6. Back-end Eligibility Verification Team An accountable team works on the back-end to verify all eligibility of patient depending on his/her visit reason of visit. Depending on eligibility team creates a financial plan and/or patient’s responsibility and communicates with FRONT DESK for further process. EHR EHR/PM System To fast track or for basic eligibility Electronic Health Record/ Practice Management systems are used to verify detailed benefits and authorizations and/or referral requirements. Detailed Telephonic Conversation Thispractice may require to call Insurance Company Representative to verify details and benefits . Highly recommended for Detailed Telephonic conversation for all new patients.

7. Patient Front Desk Process Following steps are taken to complete Patient’s Check-in and Check-out process: Verifies last date & time of last office visit Verifies demographic information till date including email id & cell. Check if referral or authorization obtained is convenient for patient Activates Patient portal and provides a brief video tutorials through email. Clarifies, if patient was ordered an outside Test/Procedure/Referral Addresses any system Alerts for Financial/Insurance Issues Completes Appointment Scheduling upon patient’s check-out Collects patient balances due to co-Insurance/Co-pay (OR) Deductible

8. Patient Engagement by Clinical Assistants With the below workflow plan, physicians will save time and are able to walk-in an exam room, review information and decide whether tests/procedures completed by their clinical assistant team were truly necessary. Generates Medication Reconciliation Documents Allergies & Current Vitals Validates primary visit Establishes History Review preventive test & previous treatment Makes list of procedures to be performed Distributes questionnaire for diagnostic tests Reviews clinical protocols

9. Benefits of Clinical Assistants Time Saving Physicians have to just walk-in, review information & decides whether tests/procedures completed by their clinical assistant team were truly necessary Accountable Care This way clinical team truly follows Clinical Guidelines to take care of patients Care Plan Management This workflow removes gap and improves risk management

10. Physician’s Workflow This is the workflow of Physicians which makes medical processes complete fast and efficient. Completes electronic chart using DRAGON or outside Medical Transcription Services. Performs physical tests, order additional lab work & diagnostic tests or referrals. Review history, allergy, reason of visit & completed tests based on clinical protocols Spends less time in chart completion & MORE time in patient’s CARE Review Examination Completion Care

11. Back-Office/Billing Team • Physician sends completed chart and the information for billing and is transferred through Electronic Super bill / Paper Super bill or Auto generated Claims through an EHR to the billing team. • Billing team in Medical Practice submits claims daily in order to forecast daily/weekly cash flow. They maintain a gap of 4 days from date of service providing enough time for physicians to finish charts, however the cycle of billing must be kept intact.

12. Communicating Communicate with patients' for high deductible / coordination of benefits / clinical questionnaire sent by health plans. Managing Denials Work on Denials within 72 hours & keep them in queue for follow up in 6-7 weeks. Submission Submit claims daily for at least 1 day of service minimum (there could be gap of few days from time of service). Posting Post daily payments and bill balances to secondary or patients. Don't wait for sending statements at the end of the month, daily closing require all actions associated with it Auditing Monthly Audit team performing audit on OUTSTANDING Primary claims and creating an action plan for follow up. important to follow up on OUTSTANDING claims once in 6 weeks for optimum cash flow. Billing Team

13. Operation Team Identify use of Technology/Outsourcing Cost Reduction Plans Discussed Monthly meetings are conducted to find available options to reduce operational costs through Automation or Outsourcing Services.

14. Clinical Reminder Team Main role is to do DATA MINING from EHR/Billing System to identify patients for Horizontal Growth as well as required visits in office. They send reminder to patient with the following methods: Email Patient Portal Operation Team SMS Automated calls/Live Representative calls Clinical Reminder Team would also be responsible for Medication Adherence and compliance for outside tests/referrals for patients. 

15. This workflow plan take practice to next level in REVENUE / COST / RISK Management and make them truly accountable in care. REVENUE RISK COST

16. Contact Us 2222 Morris Ave. 2nd Floor,Union, NJ-07083 Website http://clinicspectrum.com/ Phone Number 908.834.1608 Email info@Clinicspectrum.com Clinicspectrumis a healthcare services company providing outsourcing and back office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments.