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Ideal Practice Workflow Revenue Maximization and Cost Efficiency Contact us : 2222 Morris Ave. 2nd Floor, Union, NJ-07083 Ph: (908)-384-1608

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Presentation on theme: "Ideal Practice Workflow Revenue Maximization and Cost Efficiency Contact us : 2222 Morris Ave. 2nd Floor, Union, NJ-07083 Ph: (908)-384-1608"— Presentation transcript:

1 Ideal Practice Workflow Revenue Maximization and Cost Efficiency Contact us : 2222 Morris Ave. 2nd Floor, Union, NJ Ph: (908)

2 About Us Clinicspectrum is a healthcare services company providing outsourcing/back office and technology solutions for 17+ medical billing companies, 600+ medical groups/healthcare facilities including hospitals, and hospital medical records departments.

3 Ideal Practice Workflow Patient engagement for financial purposes begins with the CALL FOR APPOINTMENT and continues thereafter until the claim is paid in full. Let's analyze an ideal practice workflow and steps in engaging the patient effectively not only for clinical reasons but for financial reasons as well. Patient Front Desk Process Back-End Eligibility Verification Team. Appointment Call Received Back-Office/Billing Team Physician’s Workflow Patient Engagement by Clinical Assistants Operation Team Clinical Reminder Team

4 Appointment Call Received When a patient calls to make an appointment, certain key parameters are essential to obtain over the PHONE for the success of an efficient workflow management for clinical and financial planning. Phone Number Patient’s phone number is noted for future reference Gender Patient’s gender is recorded. Date of Birth Patient’s date of birth is noted. Patient’s Name Patient’s Insurance name is noted down.

5 Eligibility Determination Parameters The below 3 parameters are most essential to obtain over the phone in order to determine eligibility of the patient and define a prelim care plan for the patient at the time of service Patient’s Primary Physician Patient’s primary physician if any and reason for visit. Patient’s Insurance Name Patient’s name which has been recorded with the insurance. Insurance ID Patient’s insurance ID is recorded.

6 Back-end Eligibility Verification Team Accountable team members work on the back-end to verify all of the eligibility information of the patient depending on his/her visit depending on the visit reason. Depending on the eligibility findings, a team member creates a financial plan and/or patient’s responsibility and communicates with FRONT DESK for further process. EHR EHR/PM System To fast track or for basic eligibility Electronic Health Record/ Practice Management systems are used to verify detailed benefits and authorizations and/or referral requirements. Detailed Telephonic Conversation This practice may require a call to the Insurance Company Representative to verify details and benefits. This method of verification is highly recommended for Detailed Telephonic conversation for all new patients.

7 Patient Front Desk Process Following steps are taken to complete Patient’s Check-in and Check-out process: Addresses any system Alerts for Financial/Insurance Issues Verifies last date & time of last office visit Completes Appointment Scheduling upon patient’s check-out Check if referral or authorization obtained is convenient for patient Collects patient balances due to co- Insurance/Co-pay (OR) Deductible Activates Patient portal and provides a brief video tutorials through . Clarifies, if patient was ordered an outside Test/Procedure/Referral Verifies demographic information till date including id & cell.

8 Patient Engagement by Clinical Assistants With the below workflow plan, physicians will save time and are able to walk-in an exam room, review information and decide whether tests/procedures completed by their clinical assistant team were truly necessary. Review Preventive Tests & Previous Treatments Validates Primary Visit Establishes History Generates Medication Reconciliation Makes List Of Procedures To Be Performed Reviews Clinical Protocols Distributes Questionnaire For Diagnostic Tests Documents Allergies & Current Vitals

9 Benefits of Clinical Assistants Time Saving Physicians have to just walk- in, review information & decide whether tests/procedures completed by their clinical assistant team were truly necessary Care Plan Management This workflow removes the gaps and improves risk management Accountable Care Allows the clinical team to truly follow Clinical Guidelines to take care of patients

10 Physician’s Workflow This is the workflow of Physicians which makes medical processes complete fast and efficient. Review history, allergy, reason of visit & completed tests based on clinical protocols Review Performs physical tests, order additional lab work & diagnostic tests or referrals. Examination Completes electronic chart using DRAGON or outside Medical Transcription Services. Completion Spends less time in chart completion & MORE time in patient’s CARE Care

11 Back-Office/Billing Team  Physician sends completed chart and the information for billing and is transferred through Electronic Superbill / Paper Superbill or Autogenerated Claims through an EHR to the billing team.  Billing team at the Medical Practice submits claims daily in order to forecast daily/weekly cash flow. They maintain a 4 day gap from date of service providing enough time for physicians to finish charts, however the cycle of billing must be kept intact.

12 Auditing Monthly Audit team performing audit on OUTSTANDING Primary claims and creating an action plan for follow up. important to follow up on OUTSTANDING claims once in 6 weeks for optimum cash flow. Communicating Communicate with patients' for high deductible / coordination of benefits / clinical questionnaire sent by health plans. Managing Denials Work on Denials within 72 hours & keep them in queue for follow up in 6-7 weeks. Posting Post daily payments and bill balances to secondary or patients. Don't wait for sending statements at the end of the month, daily closing require all actions associated with it Submission Submit claims daily for at least 1 day of service minimum (there could be gap of few days from time of service). Billing Team

13 Operation Team Identify use of Technology/Outsourcing Cost Reduction Plans Discussed Monthly meetings are conducted to find available options to reduce operational costs through Automation or Outsourcing Services.

14 Clinical Reminder Team Main role is to do DATA MINING from EHR/Billing System to identify patients for Horizontal Growth as well as required visits in office. They send reminder to patient with the following methods: SMS Automated calls/Live Representative calls Patient Portal Operation Team Clinical Reminder Team would also be responsible for Medication Adherence and compliance for outside tests/referrals for patients.

15 This workflow plan takes a practice to next level in REVENUE / COST / RISK Management and make them truly accountable in care. REVENUE RISK COST

16 Contact Us 2222 Morris Ave. 2nd Floor, Union, NJ Website Phone Number Clinicspectrum Clinicspectrum is a healthcare services company providing outsourcing and back office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments.


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