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Reimbursement and Practice Management

Front and Center: Patient Arrivals

The amount of paperwork required today for patients is greater than ever. Electronic information systems can help ease the burden – yet there will be additional requirements as healthcare delivery evolves. Efficiency in managing patient information is a must for expedient patient flow.


In this article, you will learn how to:

  • Describe ways to use technologies to expedite patient check-in
  • Evaluate quantity and quality of registration forms
  • Develop patient registration and check-in processes, avoiding delays

View related pearls


The amount of paperwork required today for patients is greater than ever. In addition to gathering the patient’s medical history and demographic information needed for billing, your practice must obtain – and keep track of – several confirmations from patients. These important forms document the patient’s review of your privacy practices notice, use of data – such as ethnicity – for reporting to the government’s electronic health record (EHR) Incentive Program, details about the patient’s choice of pharmacy to facilitate electronic prescribing, among other important information. While these requirements aren’t going away, there are more efficient ways to manage them.

Try these steps to increase your practice’s odds of success in efficiently managing patient arrivals.

Get the work done before the patient arrives. Instead of waiting until the patient walks into your front office, find “touch points” – opportunities – for the patient to complete the paperwork beforehand. Allow access to forms via your website or portal. Encourage patients to complete online forms by directing them to your website during the appointment scheduling call. At a minimum, request enough information during the appointment scheduling contact to perform an insurance eligibility check.

In addition to confirming insurance coverage, validate the patient’s benefits, financial responsibility as well as his or her balance due in advance of the office visit. Conduct a financial clearance for every patient one or two days before the appointment, instead of waiting until they come to the front office. With adequate preparation, your receptionists can work faster – and better.

Use technology. Practices continue to rely exclusively on paper – even many tech-savvy practices with sophisticated websites still only allow patients to download static documents to print, complete and bring to their appointments. For optimal efficiency, interface online documents with your practice; ideally, allow patients to submit online documents directly and securely into your practice management system.

If your system won’t accept online data, permit patients to complete an online form that is transmitted securely to your practice. Your staff will be able to key in data from the form, with only a brief confirmation needed upon the patient’s arrival. If you don’t want to manage pre-visit data, offer patients tablets, iPads, or even a computer workstation for completing forms in your reception area.

Another great – and cost-effective – technology tool is the electronic signature pad. Think about the reams of paper and staff time you could save by not printing all of those privacy notices. It’s not only possible, but it’s a reality; many practices eliminate paper by presenting patients with laminated copies of the required notices and asking for an electronic signature to confirm their review.

Kiosks are another great option to help streamline the patient’s arrival. Kiosk options range from a simple computer-based sign-in that alerts the practice to the patient’s arrival to sophisticated products that gather and confirm registration data, perform insurance eligibility checks, and even collect copayments.

Evaluate forms. Review the paperwork used in your practice’s arrival process. I’ve seen all too many practices include forms only because “someone” they heard speak at a conference years ago said they should. Marry this jumble of irrelevant forms with the fact that many forms have been photocopied 64 times and are no longer legible, and you have a great opportunity for improvement!

Gather and evaluate all the paperwork you are presenting to new and established patients. Consider the relevance (do I need patients to complete this form?), as well as the content (does this make sense?). Look for errors, misspellings, grammatical errors, and repetitious or irrelevant questions. Next, consider the appearance and layout of the form (does it look professional?). Finally, consider the information that your nurse or medical assistant gather during the clinical intake process. Is there a good reason that some questions are asked twice, or is it unnecessary repetition? There’s a difference between confirming important information (patient name, medications, allergies, etc.) and collecting redundant information.

Skip the sign-in list. Practices that want to avoid the perception that patients are just transactions have tossed out sign-in lists. We’ve all come to rely on the sign-in list, but it is a vestige of the past – and an unnecessary one. Receive, greet and arrive patients as they present. Use the charge ticket or an electronic signature pad to record their arrival. If there are days – like Mondays – that a line tends to form at the reception counter, bring back the sign-in list temporarily to help process those patients. Recognize, however, that while a sign-in list may help reduce the formation of a line on a busy Monday morning, it can never replace the important job of front office employees personally greeting patients.

Time accounting. Most practices run behind, but the fact that we’re always late is actually a function of how the front office operates. If a patient is offered an appointment at 8 a.m. and that patient rarely makes it back to the exam room before 8:15 it impacts many aspects of patient flow. Add another 10 or 15 minutes for clinical intake by the nurse or medical assistant, and the office is running 30 minutes behind from the get-go.

Although some practices tell patients to come in early to fill out paperwork, most patients don’t arrive far enough ahead of time to complete the registration process. In response, many high-performing practices give patients “arrival” times that vary based whether it is a new or established patient. New patients may be scheduled to arrive 20 to 30 minutes before the actual appointment time (which should be the time that patients see you in the exam or procedure room). For established patients, your office might use the actual appointment time or provide a 15-minute window for completing the arrival process.

There is no “right” way to manage the arrival process, but it is important to recognize that the reimbursement environment has added more time – at least 5 to 10 minutes – to the arrival process. Without taking steps to incorporate this additional time at the front end, you’ll find it hard, if not impossible, to stay on schedule throughout the day. If you have not yet addressed the impact that your arrival process has on patient flow, it’s time that you do.

Pearl 8/22/13

Beyond Pen and Paper
The workstation for front office employees should include, at minimum, a computer, telephone, a scanner, pen and paper (yes, they may still need it!). A change drawer and payment processors (such as credit card swipe or terminal) are must-haves as is a remote deposit machine if you accept checks as payment. With the requirements to query payers’ websites about eligibility and other insurance issues and, perhaps, the need to input data into an EHR, all employees should have dual computer monitors – they’re an investment that will pay off in a matter of weeks.

In addition to the equipment, it’s important to also consider the location of these tools. The key is that equipment should be at the employee’s fingertips, if not within arm’s reach. Smart layout of work areas actually saves you money because you don’t have to pay the employee to walk between routine tasks dozens of times each day! Don’t just assume that your employee has everything he or she needs; take the time – at least once a year – to ask each employee, “Is there anything that I can get for you that will help make your job easier or faster?”

Pearl 8/14/13

Take a Look Up Front
If lines are forming in your reception area, patients are roomed late and employees complain about workloads, it’s time to review your front office staffing. As published in Mastering Patient Flow, patient registration consumes, on average, five to eight minutes, with established patients requiring no changes being processed in less than two minutes and new patients consuming up to 14 minutes.

While these transaction times certainly depend on the automation you deploy, as well as the components of your registration process, use these industry standards to make sure that you’re not understaffing this key area of your practice, which is more common than not. Don’t just rely on industry norms, however; clock your own arrival process to determine average transaction times for new and established patients – and be sure to track improvements after you make changes.

Pearl 8/7/13

Thank You Kindly
Give your front office employees a stack of blank “thank you” cards, ideally pre-printed with the practice logo. When a new patient arrives, address an envelope to the patient. Sign the cards at the end of the day – or perhaps send it through your office as part of the patient’s chart. Jot a message like “Thank you for choosing our practice for your medical care,” followed by your signature, and mail the card. Talk about a wow moment for the patient upon receiving your card; you not only express your appreciation, but you clearly acknowledge your recognition that the patient made a choice - and he chose you.

Pearl 8/1/13

Ten Second Rule
With the implementation of electronic health records, we’ve forgotten that patients need to be received, not just arrived. Greet patients warmly upon their arrival, ideally with their name. Train your staff to look patients in the eye, speak in a calm and pleasant tone, and smile. Remember, you only have 10 seconds – that’s the amount of time experts have measured – to make an impression on the patient. Use those initial seconds wisely.

 

United States