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Registration is an overlooked process at many practices. A welcoming, efficient registration process means happier patients, higher retention, and reduced claims denials.
First impressions count. Registration is an overlooked process at many practices, but it's most patients' first face-to-face contact with you, so it influences their feelings about you from then on. A welcoming, efficient registration process means happier patients, higher retention, and reduced claims denials.
How do you get that?
First, by hiring warm and friendly staff and training them to do the job right.
Cindy Dunn, RN, FACMPE, believes that hiring knowledgeable people is key. "Usually this is a fast-paced role, with few breaks," she says. "In the past, registration was frequently handed over to low-paid staffers who had the highest turnover rate in the practice. Instead, we should seek out experienced, intelligent people, and pay them well." Dunn is the administrator of Bluegrass Orthopaedics, a group of eight orthopedic surgeons in Lexington, Ky.
When registration is a bottleneck, you can see the signals. Patient complaints. Exam rooms standing empty while patients slog through registration. Rejected claims.
"If you have more than 2 percent insurance denials based on eligibility, it suggests you have some kind of problem in your registration process," says MGMA senior consultant Rosemarie Nelson. While it's difficult to give exact figures, she estimates one staffer should be able to register 60 new patients per day.
Nelson believes one of the best ways to limit registration problems is to get more information in advance. Some practices mail out registration forms before the first visit, while others post the forms on their Web sites. Patients can complete the form at home, fax it to the office, or bring it with them to the practice.
"When patients fax you the information in advance, that means you can verify insurance and check eligibility before they come in," Nelson says. And this doesn't require extra security for your Web site, since all you post is the empty form.
But if you like, you can create an interactive form on your Web site, which patients can complete and submit online, provided your site is secure. A secure Web site is very economical right now, Nelson says, and it's easy to find external technical assistance if you need it.
In fact, you might even be able to take information from the online form and import it directly into your practice management system, so it doesn't have to be entered a second time by hand.
Bluegrass Orthopaedics has found that posting a registration form on its Web site gets a better response than mailing it out, and it pleases patients.
"More and more people have Internet access, and they demand this kind of service," says Dunn. "They want to access the form at any time that suits them, even if it's midnight."
Another reason to gather registration information in advance is that waiting until they arrive means it will take them longer to see the doctor, or so they assume. Patients worry about how long they're going to have to wait, so they tend to rush when filling out the forms; thus the information may be incomplete or illegible.
However, if you do in-person registration, Nelson suggests at least separating the insurance information from the medical history. "In other words, hand the patient one clipboard with the demographic questions. When they hand in that clipboard give them another, with questions on medical history and current problems. Whenever the exam room is ready they can go there. If necessary, they just take the second clipboard with them and continue filling it out in the room."
Use the phone
Some practices gather registration information when patients call to schedule their first appointment. This conversation is also a good time to introduce the practice to the patient in a friendly, informal way. You can discuss parking options or practice policies, or offer the practice's Web address for additional information.
Capturing complete registration information over the phone "allows us to do pre-appointment verification of benefits, and confirm whether the patient has coverage for orthotics and prosthetics," explains Brenda Archer, an administrative specialist for Hanger Prosthetics and Orthotics, a 600-office chain based in Bethesda, Md. "If someone gives us inaccurate information, we can correct it before they even come to our office."
Archer encourages Hanger P&O offices to do real-time data entry during the initial call. This information must be documented at some point, she argues, and it turns out to be more efficient to do it during the initial contact. When the information is entered into the system and a chart prepared before the first visit, it dramatically speeds the process of preparing written cost estimates for patient approval during that visit.
As she trains people across the country to do phone registration, Archer finds she's getting a mixed reaction - and she's not surprised. "From a trainer's perspective, promoting enhancements to workflow requires changes in behavior, and that's one of the most difficult things you can ask an adult to do. They're used to doing things a certain way, so change naturally makes them feel uncomfortable at first."
You might get the same sort of resistance from your own staff. However, through frequent repetition and positive reinforcement, Archer finds that workflow processes can be improved. "When people start trying new behaviors, and discover that they really are more efficient, that strongly reinforces continued change."
Many practices reach out to new patients by sending them an introductory information packet. It may include a welcome letter, a brochure, a map to your office, information about financial policies, or a description of a typical first visit. While this information can be posted on your Web site, some patients don't have Internet access, so it's a good idea to mail out an attractive package.
As you gather advance information, remember to ask your patients for a cell phone number, just in case they're late, Nelson says. When should you call them? It depends on your practice's expectations about time. If you're often running 20 minutes behind schedule, you might call when they're 20 minutes late. If your policy is "after 15 minutes, we reschedule," then you might give them a courtesy call when they're five minutes late. It's essential to discuss this subject in a warm, friendly tone: "I just wanted to check, since we do have you on our calendar today. Are you on your way? We're looking forward to seeing you."
Don't forget about the look of your office. What do your patients see when they arrive? Are your walls empty and colorless, your furniture ratty, your carpet worn?
Liven it up a little. Put attractive paintings on the wall, or post photos of patients and letters of praise on your bulletin board. The reception area should be clean, neat, and attractive, with current magazines and newspapers. Check it throughout the day to be sure it stays that way.
The reception area should meet the needs of your particular patients. A family practice won't put a coffee pot where a child could topple it. An obstetrical practice needs large chairs, while a gerontologist needs chairs with sturdy arms. Pediatricians often set up two separate reception areas, one for routine visits and one for illness, so healthy and sick children don't have to play with the same toys.
If possible, the receptionist shouldn't answer incoming phone calls. Too often she ends up talking on the phone while a patient stands waiting patiently in front of her. Instead, encourage front-desk staff to look up from their work, make eye contact with patients right away, and smile.
Don't put a glass wall between the receptionist and your patients - that isn't very welcoming.
HIPAA now requires you to share policies on privacy and confidentiality with patients, and get their acknowledgment. This is another item you can post on your Web site.
Some practices have responded to HIPAA by blacking out each patient's name on the sign-in sheet, so the next person just sees a black line. That isn't necessary, Nelson says, calling it "HIPAA paranoia." In any case, she asks, if you have a receptionist and it's her job to warmly welcome each patient, why should anyone have to sign in?
When established patients come in, it's always a good idea to ask for their current address, and check it against your records. Don't just ask, "Has your information changed?" since few people recall exactly what they said last time.
How often should you look at someone's insurance card? If you're seeing a prenatal patient every two weeks, you needn't ask for her card at every visit. But in today's mobile economy, people change insurers frequently, so you should check every six months or so. "Scan insurance cards, and make that image part of your onscreen record. When the patient comes in and shows their card you can tell at a glance whether it's the same card they had last time," advises Nelson. "If you simply photocopy the card and file it in the chart, you'll spend too much time looking for it."
Finally, it's always a good idea to train people to do more than one job, so they can fill in during lunch breaks or emergencies. It's especially smart to cross-train your back-office billing staff and your front-desk registration staff. "It helps each of them appreciate both sides of the process," says Nelson. "Sometimes billing people feel registration staffers don't do a good job, but they don't have the practical experience to appreciate what it's like to interact with patients one-on-one all day long. When registration people work in the back office, they see the practical consequences when you don't register a patient accurately. Both will benefit from cross-training."
Elaine Zablocki can be reached via firstname.lastname@example.org.
This article originally appeared in the June 2005 issue of Physicians Practice.