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To Pre-Admit or NOT to Pre-Admit?

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(That is the question.)
Almost sixteen years ago I was employed by a for-profit ACS, and I was asked to take on the function of pre-admitting all scheduled surgical patients within one week of the procedure. As I saw it, my primary duties were to schedule surgeries, admit surgical patients the day of the procedure, manually enter all daily OR charges (can you imagine?), follow up on open insurance accounts receivable, and to take inbound customer service calls from patients. Whew. And my bosses expected me to call patients BEFORE the service actually took place and to ask them for MONEY?? Were they CRAZY?

Patients LIKE Knowing What to Expect:
I quickly learned several things:
1. I actually could fit preadmission calls into my daily schedule on top of all of my other responsibilities
2. Total charges could be estimated with a high degree of accuracy for out-patient procedures
3. Calls to verify insurance coverage and to determine the patient’s responsibility (coinsurance and/or deductible) within 48 hours of the procedure provided the most accurate data
4. I really didn’t need to apologize (not literally, of course, but I wanted to) to the guarantor when I was communicating expectations for payment on or before the date of service
Patients LIKE understanding their financial responsibility prior to the date of service! Sure, there were some challenging phone calls, but patients were not canceling/rescheduling elective procedures based on the information I was providing to them. They came to their scheduled procedure, cash or check in hand.

What is different in today’s environment?
1. Non-profit hospitals—not just aggressive, for-profit providers—are seeing the advantages of a sound pre-admission process. Improved patient expectations, increased Point of Service (POS) collections, reduced self pay receivable, reduced days in A/R, reduced collection expenses.
2. Technology has improved significantly, and there are many solutions in the marketplace to assist with online insurance verification and patient balance estimation for scheduled procedures. These applications allow for improved accuracy in pre-registration and POS collection.
3. With higher deductibles and coinsurance, self pay receivable constitutes a higher percentage of the A/R than it did 16 years ago. In a tough economy, financial counseling is essential to prepare the patient/guarantor in advance so they know what to expect—especially when the residual balance due after insurance is considerably higher than they may expect.
4. With healthcare reform and the HCAHPS survey, the patient’s perception of the overall experience has come to the forefront. Positive clinical AND revenue cycle outcomes are essential to build patient loyalty.

Yes, Pre-Admission is AN Answer

The simple answer is yes, move toward pre-admission—but it isn’t necessarily easy to implement all of the changes required to implement a preregistration process for scheduled services. For example, large facilities with 30 or more decentralized access points have challenges with managing cash and checks received when the patient presents. To accomplish POS collection, the patient has to be rerouted a second time to a centralized cashier, which isn’t conducive to improving the patient experience. Facilities with challenges should consider evaluating internal processes to make improvements.

Key Steps to Take:
1. Extensive screening of front end personnel to assess the soft skills of the staff meeting with patients and their families.
2. Invest in quality training programs provided by respected healthcare training organizations such as the National Association of Healthcare Access Management (NAHAM), or the American Association for Healthcare Administrative Management (AAHAM) that provides customized training for hospital and/or clinical staff. These organizations require continuing education to maintain certifications, and many providers use these programs as a financial incentive for personnel, as well.
3. Partner with outsourcing vendors that specialize in the pre-admission process. This improves the likelihood of highly-trained personnel utilizing the best possible technology to enhance every touch point with the patient for the best possible outcome.
4. Invest in technology to provide insurance verification and patient balance estimation on or before the date of service. It should be clear how much the patient will owe at minimum prior to the service, and whether the patient has the financial ability to meet that expectation—on or before the date of service. If they cannot, another payment arrangement should be made or an application for financial assistance should be completed at that time.
5. Centralize scheduling where possible and streamline the path the patient must take within the provider facility to reduce repetitive registration processes that may result in additional errors after the initial registration has taken place. The patient’s perception of a multiple registrations as they follow their plan of care is not favorable when the same information is requested over and over again, especially when they are required to wait at yet another registration desk in the provider’s diagnostic maze.

I encourage further reading, such as Steve Chrapla’s article in this issue of the Iowa Network newsletter, “Can External Call Centers Benefit Hospital’s Access Departments?”

Deanna is a dynamic revenue cycle professional with over 20 years in the healthcare space. You can connect with her on LinkedIn at