Managing the Healthcare Revenue Cycle, Part 1: Pre-Encounter Appointment Scheduling

When your healthcare organisation prospers, you positively impact the lives of everyone you touch: patients, staff, business partners and your larger community.

The more efficiently you can work through the administrative demands of scheduling patients and processing their payments, the more people you can help. As your organisation grows, your business partners will enjoy stronger support and the greater community will benefit from a healthier, more prosperous population.

It all begins with tighter operational efficiencies and lower costs so that more of your revenue converts into profits.

To make that happen, organisations are continually being asked to take on greater responsibility for dwindling reimbursement. They must assure adequate cash flow for normal operations, come up with innovative ways to lowering expenses, provide a reliable substrate for informed business decisions, and stay current with all of the latest legal and tax updates.

It would be impossible without advanced software and intelligent resource management strategies.

Over the past few years, the world's most successful healthcare organisations have identified a series of best practices that assure more efficient and productive operations with more financial control.

Collectively, this set of best practices governing the use of financial software and patient administration strategies are known as Healthcare Revenue Cycle Management (HRCM). Here's how it works.

9 Stages of Claims Processing Transactions

The stages of HRCM cover all the major events in a patient's interaction with your organisations - from first contact to final reconciliation of the patient accounting data. There are nine stages of claims processing that fall into three categories:

Pre-encounter Transactions

  • Stage 1: Appointment scheduling
  • Stage 2: Pre-registration
  • Stage 3: Point-of-service (POS) Patient Responsibility

Transactions During the Encounter

  • Stage 4: Healthcare Information Management (HIM)
  • Stage 5: Service Coding
  • Stage 6: Medical Case Management

Post-encounter Transactions

  • Stage 7: Payment Posting, Validation, and Reconciliation
  • Stage 8: Follow-up, Denial and Appeals Management
  • Stage 9: Contract Management

This article will concentrate on the first stage of that process, with software and strategies that will help you do more up front before the patient arrives.

Stage 1 of Healthcare RCM: Patient Appointment Scheduling

There are several administrative actions that intelligent software can handle in the days before the patient comes in for an appointment. The healthcare revenue cycle suggests that manual tasks should be automated wherever possible and once data enters your network, it should be able to flow freely between systems instead of requiring repetitive entry actions from patients and staff throughout the process.

In many places around the world, healthcare providers are still using ancient technology like paper and pens. Staff has to jot down appointments on a paper desk calendar or enter patient data into a computer-based calendar that isn't set up to communicate with other systems.

Those traditional approaches are not effective for growing patient rosters and tighter security regulations on handling patient data. You need a way to share information seamlessly across many platforms, yet do this with the highest security protections.

In leading healthcare organisations, the physicians and staff are able to easily check their upcoming appointments remotely and patients are able to set up notifications and reminders of upcoming appointments by phone, email or text.

It is likely that there will still be some components of cost-sharing caps mandated by new government regulations. Expect challenges in determining the right amounts to charge patients and other payers. One of the solutions suggested by RCM is account payable document management software. The more this process is automated, the easier it is to ensure compliance as regulations and oversight change.

Moving into Stage 2: Patient Pre-registration

Long before the patient arrives, a great deal of pre-registration data can be collected and analysed to simplify the process going forward. The reduction or elimination of forms to fill out does double duty. It reduces your costs and it improves the patient's experience.

In the next article, you will learn what it takes to rapidly capture patient data and then integrate it simply into your electronic medical record.