Computer Aided Patient Scheduling for Improved Medical Billing Service Performance

By Yuval Lirov

Without a computerized scheduler, a practice has less than 2% chance to earn the title of a "better performing practice," according to Medical Group Management Association. Massive investment in scheduling features across a wide spectrum of billing products is another indication of importance of computerized scheduling: during May and June of 2006, Billing Wiki cited twenty-six software products that offer some aspect of patient scheduling.

Convenience and front office efficiencies are two obvious benefits of a computerized scheduling system, since without it, the only manual way to find out if a specific patient has a scheduled appointment is to flip through the appointment book page by page. Worse, manual scheduling hurts both patient satisfaction and practice financial performance because of scheduling inconsistencies and unbilled (and therefore unpaid) visits respectively.

But the benefits of integrated computerized scheduling stretch far beyond convenience, front office efficiencies, and better charge followup of a stand-alone, albeit computerized, scheduling. A well-designed and integrated scheduler allows preferential patient scheduling, which, along with improved controls, helps revenue optimization and practice compliance. Below we review key aspects of computerized scheduling and demonstrate important benefits of integrated scheduling, billing, and compliance management.

Scheduling Policies

Computerized scheduler allows combination of single- or multiple-interval scheduling with open-access scheduling subject to various priority constraints. Such priority constraint-driven open-access scheduling creates preferential appointments based on patient demographics or insurance coverage.

Single-interval scheduling allocates appointments at regular intervals, every 5 to 15 minutes, depending on specialty. The downside of single-interval scheduling is that as soon as one appointment takes longer than allocated slot, all subsequent patients will have to wait.

Multiple-interval scheduling also sets appointments at regular intervals, but, unlike single interval scheduling, it allocates the length of the appointment depending on chief complaint. Such scheduling requires upfront categorization of key appointment kinds and their projected lengths. For instance, an initial appointment might take 30 minutes, while a routine injection might take only 5 minutes.

Open-access scheduling requires holding open several appointments every day. These open appointments are filled only within 48 hours of the appointment, catering to the same day or last-minute patients requests. Open-access scheduling improves access to physician, reduces no-shows, and eliminates patient screening time. The downside of open-access scheduling is, of course, the potential for longer patient waiting lines or physician idle time because of the inability to maintain predictable patient flow.

One way to balance practice workload is to schedule group, routine, or repeat appointments during slow hours. For instance, pediatric well-child visits or patients with a particular chronic disease, such as, congestive heart failure or diabetics, could be scheduled for early mornings, when there are typically fewer patients waiting in line. These scheduled visits include educational components and often involve multidisciplinary teams. Patients also benefit from socialization aspect of group visits, as members encourage one another, exercise together, and so forth. A good scheduler will allow repeat appointment schedule subject to total frequency and time slot constraints.

Compliance Process

Integrated scheduler verifies the filing of a signed patient consent form, and, in certain cases - signed ABN form. ABN serves three goals: protect the beneficiaries from liability for services denied as not reasonable (depends on frequency or duration) and necessary (depends on diagnosis and provider's specialty), protect the provider's revenue by shifting financial liability for denied services to the patient, and provide documentation for Medicare audit. For more complex procedure, the scheduler warns the front office about the need to obtain upfront all of the required diagnostic test results and clearances.

Billing Interface

Integrated scheduler avoids unbillable patient encounters and reconciles visits with patient balances. It checks outstanding patient balance, and verifies coverage and eligibility at the point of schedule, prior to appointment. In many cases, such a test discovers data entry errors too, reducing payment cycle at later stages.

Additionally, the insurance company may require referrals or separate pre-authorization/certification for certain procedures refusing the payment if the procedure was performed without a referral or pre-authorization. The integrated scheduler has access to medical records to supply necessary background and diagnosis information to obtain pre-authorization. Finally, without the ability to reconcile visits with payments, the practice owner cannot be sure that every visit resulted in payment.

Practice Flow Interface

Integrated scheduler manages the entire patient flow, providing continuously updated arrival lists, check offs, and office/room tracking. Further, the scheduler tracks no-shows and followup actions. Detailed reports include daily schedules, load reports, missed appointments, free time, canceled appointments, etc.

Patient Interface

Advanced schedulers include appointment reminders and provide online registration, and online scheduling request forms. Online scheduling request forms must take into account the risk of scheduling patients beyond the scope of the practice, which a live operator would have screened out.

Summary

Traditional stand-alone scheduling systems reduce idle time for employees, lower provider frustration, and reduce patient waiting time. Modern integrated schedulers accomplish more ambitious goals of increasing revenue, reducing administrative costs, and shortening billing cycle. An integrated Vericle-type scheduler handles multiple providers, locations, scheduling policies, and patient preparation processes, and has bi-directional compliance and billing interfaces. Most importantly, an integrated scheduler implements preferential scheduling policy consistently and independently of office staff.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com

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