To increase the practice revenue and reduce the cost ‘ideal practice workflow’ plays a vital role. The workflow in any organisation is the user interface between the team members and the IT system. Following are the steps to effectively engage patients for clinical and financial reasons both,
A- Appointment call
The workflow begins with the patient's appointment. When a patient calls to make an appointment, several essential parameters must be taken over the phone in order to successfully manage the workflow for clinical and financial planning.
The patient's demographics, the insurance provider's name, any physicians, and the visit's purpose are all crucial information. To determine the patient's eligibility and create a basic treatment plan for the patient at the time of service, the aforementioned information must be gathered over the phone. A patient's address, guarantor, employment type, job, and employer can all be determined when they first walk into the clinic. Later practice workflows are fueled and supported by this information.
B-Eligibility verification
A back-office insurance eligibility team determines each patient's eligibility based on their reason for visiting. Fast track or basic eligibility can frequently be confirmed via an EHR or practice management system, however for particular visit types, phoning an insurance carrier representative may be necessary to confirm specific needs. We strongly urge comprehensive telephone verification for all new patients. Returning or ongoing patients can use online or EHR/PMS substitutes. The front office team and the backend eligibility team work together to organize the essential actions before the backend eligibility team creates a financial plan while accounting for patient accountability.
C- Process patient check-in and check out
Upon the patient's arrival, the information obtained during the phone call is confirmed, more information is gathered, and the patient is informed and educated. The following information needs to be verified:
1- Verify the last office visit's time and date.
2- population data that has been updated.
3- Update your email and mobile number.
4- Send out a quick video guide and set up the patient portal.
5- Replying to queries about finance and insurance.
6- During check-out, schedule a follow-up appointment.
7- Ensure that prescriptions, referrals, and authorizations are given to patients.
D- Patient engagement
Prior to doctors examining, diagnosing, and treating patients, it is crucial that medical assistants set up patients with all the necessary clinical information readily available to clinicians. Medical assistants must perform triage and/or pre-visit preparations. Current includes making sure that between their previous appointment and this one, all test, procedure, and lab results are in the EHR. The records of any consultations or hospital stays are also scanned in. Before entering the exam room to treat patients, clinicians should create daily huddle sheets or checklists. Instead of performing visit-related secretarial tasks, providers' time should be respected and used for examination, clinical decision-making, and documentation. As much work as possible from the doctor to the suitable staff members can be delegated in order to considerably boost the productivity of a practice.
E- Bill generation by the billing team
When the chart is complete, billing information is transferred to the billing system using the electronic superbill. The money flow is disrupted by the haphazard way many practitioners submit claims. For determining the ultimate cash flow, the following billing cycle is essential. The billing team should file claims on a daily basis in order to forecast daily and weekly cash flow. Doctors will have adequate time to complete the charts if there is a four-day gap after the date of service, but the billing cycle must be maintained. The billing team must follow a strict (yet well-planned) procedure dictated by financial regulations. Daily claims for a minimum of one day of service are required for this procedure (though some short gaps are allowed).
-Post the payments made each day and any outstanding balances to the insurance or the patients. Not at the end of the month.
- React to rejections within 72 hours. Maintain them on the follow-up waiting list for 6-7 weeks.
- Explaining high deductibles to patients,
- Coordinating the benefits and health plan