Wrong PCP? Correct information before arrival
Lack of referral is issue
Before a pre-registration department was created at the organization, insurance requirements for patients to identify a primary care provider used to result in delays in scheduled procedures fairly often, until a pre-registration department was created, says Bettye Sabree, MHA, director of pre-registration and centralized referrals at Cambridge Health Alliance in Medford, MA. “When the patient came in and we checked eligibility, in a lot of cases, the patient did not know that the doctor they were coming in to see was not the doctor listed with their insurance company,” she explains.
This situation meant that patients covered by commercial insurance were asked to sign a waiver and leave a visit deposit instead of just a copay, and they would end up receiving a bill, says Sylvia C. Motta, manager of pre-registration and the call center.
Even if the patient was willing to take the time to update the information on the spot, it took up to 20 minutes to complete, which disrupted the provider’s schedule. “Now, staff take care of this before the patient comes in,” says Sabree. “They establish a three-way conversation on the phone between the patient and themselves and the insurance company. They work with the patient to select a primary care provider, if that’s what the patient wishes to do.”
The new system addressed the number one concern of providers: to keep their schedule going smoothly. “The flow has to be continuous, especially for providers offering same-day access,” says Motta. “One delay like this about insurance issues can throw their whole schedule off.”
Previously, providers were unable to refer the patient for specialty care, as technically they couldn’t give a referral to a patient who wasn’t theirs. If the provider wanted to take the patient to surgery, for example, they would find they could not, because the required authorization wasn’t in place.
“If there is no referral in place with the primary care physician, that provider encounters delays trying to schedule that procedure for the patient,” says Sabree. “But if everything is aligned prior to check in, it all goes smoothly.”
The electronic scheduling system has been programmed to capture the names of patients who have been scheduled with appointments and meeting preregistration criteria, which appear on a Pre-Registration Department worklist. These patients will receive a preregistration telephone call from the department. If the Preregistration Department doesn’t speak with the patient directly, for any reason, their insurance is still confirmed electronically using insurance company verification systems and staff notes are entered beside the patient’s name on the appointment schedule to indicate what is needed.
“Examples of messages include ‘Primary care provider update needed with insurance company,’ ‘Verify the patient’s date of birth,’ or ‘Obtain subscriber information,’” says Sabree. “When the patient checks in, the front desk can clearly see what is needed.”
Before a pre-registration department was created at the organization, insurance requirements for patients to identify a primary care provider used to result in delays in scheduled procedures fairly often, until a pre-registration department was created, says Bettye Sabree, MHA, director of pre-registration and centralized referrals at Cambridge Health Alliance in Medford, MA.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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