MDapproach™ Solution 2: Patient Access Improvement

Definition: The patient access cycle includes the flow of information and patient activity that occurs before and during the patient visit.  Such activities would include patient scheduling, registration, referral management, co-payment and potentially charge entry activities. The “front end” processes are critical to an effective revenue cycle.

Objective: To determine how well these activities set the stage for the work that needs to be carried on in both the clinical episode and the billing office. To schedule the patient within the correct timeframe, with the appropriate clinician, and with the correct clinical information.

Timeline:  Four to six weeks

Sample Work Performed:  An assessment of the current state of the following:

Deliverables: Gap analyses of each area, identifying future state workflows and optimization opportunities based on findings.  

Sample Client Outcome:  Hayes conducted a review of the patient access for a large academic practice. The assessment indentified the following issues:

• Need for individual practices to modify the master schedules
• Multiple systems utilized to obtain referral and authorization information, resulting in incorrect or missing certifications
• Lack of consistent insurance eligibility and demographic verification
• Need for collection of copays and patient balances at check-out
• Need for edits during charge entry

The client was able to implement or improve several of the functional elements of the billing system to address these needs. Electronic eligibility was implemented as was the use of edits at time of charge entry to decrease missing or incorrect data entry. Front desk procedures were also implemented to improve the authorization and registration process to ensure accurate information on each patient visit.

Revenue Cycle Solutions:

Overall Revenue Cycle Improvement
Patient Access Improvement
Clinical Workflow Optimization
Denials Reduction
Information Systems Assessment