1. The 3 P's to Perfect Your Pre-Encounter

2. The Problem Double-digit denial rates Cash flow
Patient billing responsibility
Most providers are facing double-digit denial rates, which is impacting cash flow.
Nearly every provider is dealing with cash flow problems today.
Patients don’t know what they owe.

3. The Opportunity = 3 Ps Process = Cut denial rates by half
(was 10% now 5.7% soon to be 3.0%)
Patient = Better understanding
Working with Cone Health Network who cut their denial rates from 10% to 5.7% and on pace to bring that down to 3%
The second piece in the puzzle is the patient’s responsibility.
Cone had a goal of increasing cash flow to $100k per month and within 3 months they beat that by 33% and brought in $400k.
Payment = Boost cash flow $100k/month

4. Highlights Defining the bottom line
Centralization of scheduling: the key to success
Defining where you are and where you will go
Develop and deploying a process
Training
Tracking, measuring, and evaluating the success

5. The $6 Million QuestionTM
On a scale of 0 to 10, how well do you communicate your patients’ payment responsibility?

6. John Cook Why should you listen to me?
Served as Revenue Cycle Director for 22 years
Pro Recovery, Inc. = Worked with more than 100+ hospitals on improving their revenue cycle
Reducing AR days from over 100 to 55 days
Advising and mentoring hospital managers
National HFMA Yerger Award for Outstanding Performance in Education

7. Lesson #1: Define your bottom line.
Define why you are implementing a pre-encounter process.
What efficiencies do you want to realize?

8. Here is what your colleagues said
Consistency
To create efficiencies to promote patient satisfaction and financial accuracy by education patients prior to service
To educate the patient, financially and clinically
Customer service
Reduce errors / streamline and improve the patient experience
Pre-financial screening
Patient Friendly!!
Financial clearance and education
Get it right the first time
Scheduling
Customer service and collection of money
Obtain authorization
Implement a new program
Source: Answers given by attendees of NCHFMA Roundtable Discussion on Pre-Admission Procedures and Best Practices, July, 2012

9. Bottom Line: 5 Key Elements
Cleaner claims
Patient payment issues
Communication of payment expectations
Asking for payment upfront
Service excellence
Gathering accurate and up to date information is the single most critical piece of the patient admission process: The result will be cleaner claims which will result in less denials and faster turnaround. This is the high dollar piece.
Financial clearance for patient: Determine any patient issues and challenges they may have in paying their bill. This is the opportunity to offer other options such as Medicaid, assistance in applying for insurance through the Affordable Care Act, clearing up any past due accounts, or determining possible charity care or financial assistance.
Communication of expectations: This is the opportunity to provide the patient with estimates and potential balances after insurance pays. Providing expectations will assist the patient in planning for these expenses.
Pre-Service collection: Simply stated, asking for money up-front (i.e. deductibles, co-pays, past due debts, deposits).
Service Excellence: Make the difference. Create the first impression
Denial rate, speed of approval, how much do you convert into cash. Each one have an example of how to track that.

10. Lesson #2: Centralize Scheduling
The foundation of a successful pre-encounter process
Scheduling is a patient access function
One calendar
One location
Everyone on the same page
The foundation of a successful pre-encounter process: Bring it all under one roof.
Scheduling is a patient access function. Own it.
One calendar for all procedures: Scheduling calendars must be a part of the overall software package with the ability to create a work file for patient access representative to work from.
One location: A Team
Everyone on the same page: Playing by the same rules, seeking consistent information.

11. Lesson #3: Define where you are and where you need to go
Rate your responses on a scale of 0 to 10, 0 = extremely poor; 10 = extremely well.
____ Overall, how would you rate your pre-encounter program?
____ How would you rate the information you get from patients?
____ How would you rate your clean claims?
____ How would you rate your scheduling software?
____ How would you rate your scheduling process?
____ How would you rate your insurance eligibility capabilities?
____ How would you rate your ability to estimate charges?
____ How would you rate your ability to refer uninsured patients to their payment options?
____How would you rate your current collection policies and procedures?

12. Lesson #4: Develop and Deploy a Process
Act
Centralize scheduling
Secure technology
Establish a plan and timelines
Complete buy-in
Act on your assessment. This is the starting point
Taking the action needed to centralize scheduling
Secure up to data technology
Establish the plan and timelines
Complete “buy in”: Support of administration, support of nursing, support of all departments involved (surgery, radiology, outpatient surgery, etc.)

13. Lesson #5: Train, Inspire, Create
Create passion
Ask for money
Create service excellence
Communicate expectations
Create passion for the role,
Train staff how to ask for money
Train staff how to relate to patient and create service excellence
Train staff to communicate expectations
Example: Ken’s overall bottom line wasn’t not necessarily to get the co-pay but to communicate the patient’s payment responsibility. The cost of the procedure is ________ and your insurance will likely cover __________ and therefore your balance will be _________. If there are any issues with you paying that amount we would like

14. Lesson #6: Track, Measure, and Celebrate the Success
Reduction in AR days
Increase in clean claims
Increase in point of service collection
Increase in patient satisfaction scores

15. A Successful Process: Cone Health
High denial rates
Boost cash flow
Training
Reduce denial rates to 3%
Increase cash flow by $100,000 per month through pre-service
Epic system lacked in estimation
Estimation package purchased
New policy and procedure approved by Administration
Awareness of problem: High denial rates and the need to boost cash flow
Determination of the bottom line
Review of current Pre-Encounter and Pre-Admission process
Goals and Timelines
Centralization of scheduling
Review of current in-house software capabilities
Review of technology
Purchase and installation of estimation software
New policy and process buy in
Setting up separate Pre-Service Center off campus
Creating the environment
Training

16. Results: Cone Health Reduction of denials to 5.8% from 10%
Pre-Service collections at $400,000 average of $133,000 per month

17. Summary Questions Where are you in this process?
What is your biggest obstacle?
What are your failures?
What are your successes? 
Ask the question, what has been stopping you.
What is the wall that you are going to hit.
Who do you need to convenience.
Other departments?
What suggestions from you who have dealt with this? Get the roundtable going. Audience interaction.

18. Now ask yourself the $6 Million QuestionTM
If you put in place just a few of these ideas…
How well could you communicate your patients’ payment responsibility?

19. Quick Start Consultations
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20. E Book: The Six Million Dollar Question
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