Mastering the art of the previsit.
What's the single-most financially critical phase of patient interaction? No, it's not collections. It's actually the previsit. That's because the information you gather at this stage saves time and money at every step down the line through to payment. Doing it well is part of what we call preventive management, and it is one of the fundamental principles of the Unified Theory of practice management introduced in this column last month.
Claim problems get more expensive and less likely to be resolved the longer they go on. The concept of preventive management simply says that the most cost-effective approach is to detect and address problems as quickly as possible, and prevent them completely wherever possible.
The previsit phase, then, is all about prevention. If you know that you will be paid, how you will be paid, and what you will be paid for the visit before the patient arrives, you are well on the way to maximizing collection with minimal fuss. Specifically, good previsit procedures net benefits in four areas:
As you improve your ability to accurately forecast no-shows and other scheduling factors, your wait times are also going to improve.
In our experience, the average practice should be doing preauthorizations on 5.5 percent of its claims, and referrals for 27.5 percent of its claims. (These are difficult numbers to pin down precisely because guidelines can be somewhat hazy for certain payers. In any case, the percentages can be much higher, depending on the types of practice.)
PREVISIT BEST PRACTICES
So if previsit prep is so important, what are the best practices for previsit routines and procedures? Looking at the performance of thousands of practices across the country, we have identified the tips and tricks that work best to get patients to their appointments, on time, almost all of the time and with their paperwork and payments in line.
Previsit work breaks down into these areas:
We'll examine this complex topic in the fullness it requires next month. For now, it's sufficient to say that eligibility-related denials are the most common variety, and that previsit is the ideal time to establish eligibility.
APPOINTMENT REMINDERS AND NO-SHOWS
Reminders can be a time-consuming process, but compared to the time wasted on no-shows and preventable collections activities alone, they are among the most cost-effective uses of staff-time.
Here are some tips for doing them right:
And here are some pointers for dealing with no-shows:
PREAUTHORIZATION AND REFERRAL
It is very important to develop, document, and enforce standardized policies and procedures for obtaining preauthorizations and referrals prior to a visit. These procedures will necessarily be customized to the unique circumstances of your patient and payer mix, but consider including the following:
Having a documented and standardized set of chart prep policies and procedures is also a critical success factor for improving your previsit readiness. As you develop your policies, consider including these:
Contacting all of your patients previsit will yield great rewards. Contact as many top-priority patients as possible in person and use postcards or technology for the rest.
Gavin Hoopes is engagement manager for athenahealth, a revenue cycle management company for medical practices whose database of billing information is the statistical basis for this series. He can be reached via firstname.lastname@example.org.
This article originally appeared in the March 2006 issue of Physicians Practice.