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The 3 P's to Perfect Your Pre-Encounter

The 3 P's to Perfect Your Pre-Encounter. The Problem. Double-digit denial rates Cash flow Patient billing responsibility. The Opportunity = 3 Ps. Process = Cut denial rates by half (was 10% now 5.7% soon to be 3.0%). Patient = Better understanding.

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The 3 P's to Perfect Your Pre-Encounter

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  1. The 3 P's to Perfect Your Pre-Encounter

  2. The Problem • Double-digit denial rates • Cash flow • Patient billing responsibility

  3. The Opportunity = 3 Ps Process = Cut denial rates by half (was 10% now 5.7% soon to be 3.0%) Patient = Better understanding Payment = Boost cash flow $100k/month

  4. Highlights • Defining the bottom line • Centralization of scheduling: the key to success • Defining where you are and where you will go • Develop and deploying a process • Training • Tracking, measuring, and evaluating the success

  5. The $6 Million QuestionTM On a scale of 0 to 10, how well do you communicate your patients’ payment responsibility?

  6. John CookWhy should you listen to me? • Served as Revenue Cycle Director for 22 years • Pro Recovery, Inc. = Worked with more than 100+ hospitals on improving their revenue cycle • Reducing AR days from over 100 to 55 days • Advising and mentoring hospital managers • National HFMA Yerger Award for Outstanding Performance in Education

  7. Lesson #1: Define your bottom line. • Define why you are implementing a pre-encounter process. • What efficiencies do you want to realize?

  8. Here is what your colleagues said • Consistency • To create efficiencies to promote patient satisfaction and financial accuracy by education patients prior to service • To educate the patient, financially and clinically • Customer service • Reduce errors / streamline and improve the patient experience • Pre-financial screening • Patient Friendly!! • Financial clearance and education • Get it right the first time • Scheduling • Customer service and collection of money • Obtain authorization • Implement a new program Source: Answers given by attendees of NCHFMA Roundtable Discussion on Pre-Admission Procedures and Best Practices, July, 2012

  9. Bottom Line: 5 Key Elements • Cleaner claims • Patient payment issues • Communication of payment expectations • Asking for payment upfront • Service excellence

  10. Lesson #2: Centralize Scheduling • The foundation of a successful pre-encounter process • Scheduling isapatient access function • One calendar • One location • Everyone on the same page

  11. Lesson #3: Define where you are and where you need to go Rate your responses on a scale of 0 to 10, 0 = extremely poor; 10 = extremely well. • ____ Overall, how would you rate your pre-encounter program? • ____ How would you rate the information you get from patients? • ____ How would you rate your clean claims? • ____ How would you rate your scheduling software? • ____ How would you rate your scheduling process? • ____ How would you rate your insurance eligibility capabilities? • ____ How would you rate your ability to estimate charges? • ____ How would you rate your ability to refer uninsured patients to their payment options? • ____How would you rate your current collection policies and procedures?

  12. Lesson #4: Develop and Deploy a Process • Act • Centralize scheduling • Secure technology • Establish a plan and timelines • Complete buy-in

  13. Lesson #5: Train, Inspire, Create • Create passion • Ask for money • Create service excellence • Communicate expectations

  14. Lesson #6: Track, Measure, and Celebrate the Success • Reduction in AR days • Increase in clean claims • Increase in point of service collection • Increase in patient satisfaction scores

  15. A Successful Process: Cone Health • High denial rates • Boost cash flow • Training

  16. Results: Cone Health • Reduction of denials to 5.8% from 10% • Pre-Service collections at $400,000 average of $133,000 per month

  17. Summary Questions • Where are you in this process? • What is your biggest obstacle? • What are your failures? • What are your successes?

  18. Now ask yourself the $6 Million QuestionTM If you put in place just a few of these ideas… How well could you communicate your patients’ payment responsibility?

  19. Quick Start Consultations Available from John Cook at no cost Contact Information jcook@prorecoveryinc.com 828-773-4466 (Cell) 866-907-8023

  20. E Book: The Six Million Dollar Question How to reduce denial rates, improve patient satisfaction and increase cash flow. Sign up TODAY to get your copy sent to you via email… www.6milliondollarquestion.com

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