No authorization for same-day service?
Authorizations for high-dollar diagnostic tests are the single biggest problem with same-day scheduling, according to Wendy M. Roach, RDMS, manager of patient access and central scheduling at Advocate Good Shepherd Hospital in Barrington, IL.
If patients are scheduled for a test the same day or the next day, physician offices don't have enough time to complete the pre-authorization that is required, in part because payers are asking for clinical information.
"We would be happy to complete the pre-authorization, but insurance companies are requiring the physician offices to provide the patient's history along with signs and symptoms," Roach says.
Because of this situation, about 10 patients are being rescheduled every week at Advocate Good Shepherd Hospital. "This becomes not only a patient dissatisfier, but also something that is difficult on your bottom line," says Roach. "In some cases, we write off the amounts."
These steps now occur for same day scheduling:
When schedulers put the appointment in the system, they send a fax to the provider's office informing them of this appointment.
"The biggest challenge is that the physician office is required to complete the process," says Roach. "A lot of the time, they do not have the manpower to complete it in a quick window."
A fax is sent to the pre-certification department for follow-up.
"If the patient is same-day or next day, we indicate that on the top of the fax so that it is easily identified," says Roach.
The pre-certification department contacts the physician office to follow up.
"Scheduling is not the issue. You can always manipulate what you need to squeeze a patient in," Roach says. "But if you don't get the authorizations, you could be writing off more then you planned."
Time carefully
Because authorizations usually require clinical information that the scheduler doesn't have access to, the process often needs to be originated by the ordering provider office, explains Jennifer Nichols, director of patient access at Spectrum Health in Grand Rapids, MI.
"This must be timed carefully to be done in advance of the service, or options for retro-authorization should be identified in advance with payers," says Nichols. "Some may allow retro-authorizations based on specific thresholds or medical necessity."
Typically, an authorization is requested by the ordering provider's office, as it requires information from the medical chart, and the authorization is then verified by the scheduling team.
"We may update it if necessary. For example, some authorizations list the service location, so we may need to enter in a different location the service will be provided at," says Nichols.
Authorizations for high-dollar diagnostic tests are the single biggest problem with same-day scheduling, according to Wendy M. Roach, RDMS, manager of patient access and central scheduling at Advocate Good Shepherd Hospital in Barrington, IL.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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