The short answer is YES. But there is so much more about scheduling than most individuals would take into account that can drive a positive or negative impact on your entire revenue cycle.
I am going to break this into two parts; part one: set up and part two: data entry. The article will be a high-level discussion with a few examples in hopes that you will want to dive deeper into your organization scheduling practices to improve your overall performance to increase your revenue.
So let’s get started part one: set up. When a provider comes on board with your practice or hospital system, you need to think about scheduling. When will the provider be in the office, in the hospital or practice for procedures, rounding in the hospital or nursing homes, call coverage, and time-off? Scheduling is so much more than just a patient calling into the office or hospital to schedule an appointment or service. It is ultimately the providers time, facilities time, and equipment time. At any point during the scheduling process if done incorrectly it can lead to patient dissatisfaction, provider dissatisfaction, slowness or delays in procedures or services, and revenue impact. So the most important part of scheduling is the setup, and if done incorrectly, it will cause more havoc in your life as operators and revenue cycle leaders. Right now, the practice managers/operations leaders are saying Cissy revenue cycle leaders don’t need to worry about scheduling. But I would disagree; scheduling is what drives our revenue cycle. If the revenue cycle managers don’t understand the scheduling process, then you will feel the impact. I would strongly suggest that the operations leaders and revenue cycle leaders work closely together to maximize the schedule to ensure that proper revenue is captured at the time service.
Next step in the set-up is the design of the scheduling templates. Templates are the lifeblood of the practice or hospital in the sense that it drives the provider’s, facility, or equipment productivity which is a BIG part of the revenue cycle. If the schedule doesn’t allow for the provider to see a certain amount of patients, then the provider's productivity will be affected. Productivity is critical to the operations in healthcare, and I will be discussing this topic more in another article. But for now here is a little tidbit of information about provider productivity: Did you know that for a family practice/internal meds/pediatric/ob-gyn practice to break-even the provider needs to see 22+ patients a day, for a specialist the provider would need to see no less than 15+ patients a day! If the scheduling template doesn’t allow for that amount of patients seen each day, you could be setting yourself up for negative impact in your revenue cycle. Now if you are a provider, you may be saying to me Cissy this is unrealistic for me to see more than ten patients a day! It may be the case if you are a highly sought after specialist to which you are in the hospital doing procedures every day and only seeing patients one or two days a week in the office. But if you are family practice or internal medicine provider and you are not seeing 22+ patients you will not break-even, and I can guarantee you will lose revenue, resulting in loss of income.
If we are talking about facilities and equipment scheduling, it is vital that the schedules are managed and available for the provider to refer their patients. For example, a cardiology physician refers their patient to have an Echo (this is an ultrasound of the heart). The facility doesn’t manage their schedule and times for the tests appropriately, resulting in the patient not able to get in to have the test, or they have to wait a long time for the test. It will cause patient dissatisfaction but also the cardiologist will also be dissatisfied. If the facility is known for these types of scheduling mishaps, the cardiologist may elect to send their patients to another facility. If that happens, then the facility will lose revenue because of lack of referrals.
It is important to remember that template setup is unique to providers and trying to set one-size fits all template for providers is a disaster. However, there is nothing wrong with giving guidance and expectations when providers are discussing their templates. Most PCP providers will hit the 22+ patients a day if they are doing 10 min to 15 min appointment slot schedule and most specialist providers will hit the 15+ patients day if they are doing 30 minutes or fewer appointment slots. Once a template is created you shouldn’t change the template’s parameters unless there is a significant shift in the provider’s hospital schedule or call schedule. Otherwise, templates should be evaluated only if the provider needs to open the schedule up for more time slots; or the provider is slowing down toward retirement or for the once a year evaluation. If a provider decides to make alterations to the schedule on a frequency basis it will cause confusion for the individuals who schedules for the provider. It will also cause productivity misses for the provider. It is a recommended that providers must discuss changes to their schedule with their operators to ensure that there will not be a revenue impact for the practice and provider.
Part two: data entry. At this point, the schedules are in place, and we are ready to schedule appointments for the providers and facilities. Now we have reached the critical part – data entry! This is where it all happens for a successful start of the revenue cycle. Some revenue cycle leaders will debate this topic should we take all the demographic and insurance information at scheduling or should we capture the least amount of information and have the front office get the information? I will tell you right now that I am the opinion that you MUST get all the information at scheduling! Why, because the more information you have, the better the front office check in experience will be for the patient and fewer denials on the back end of the revenue cycle. Data entry is the key! When the patient calls into the office; gathering as much information about the patient’s demographics and insurance will allow the practice to ensure that patient’s data and insurance verification is completed correctly before the patient comes into the office. If there are any issues, then those can be addressed before the patient arrives, or at the time of arrival. As revenue cycle leaders, when you are building your process and procedures either in policy form or guideline form, your scheduling process should be written out in detail with screen shots for the associate to follow. By taking the time to build the document, it will provide the right guidance and expectation on how scheduling is to be performed in your office. If you have a large practice of more than eight providers, the revenue cycle leader and operator should build what I call a scheduling profile for all providers and tests. This profile should be available to all schedulers. The profile is essential; it tells the scheduler how to schedule for a particular provider, dates and times, preferences, etc. By providing this information, the data collection is easier for the scheduler, and there are less scheduling mistakes.
Scheduling can happen in different ways; most individuals think that the only way to schedule an appointment with the provider or facility is to call. But we have so much technology now that we can allow the patient to schedule their appointments and enter their information. By allowing the patient to schedule their appointment via the portal, you will eliminate the amount of calls coming into the office, plus the patient has some control over when they want to come into the office. An example of these types of appointments that could be schedule through the portal is an adult physical, well checks for children, or particular sick appointments. Most healthcare EMR’s have this ability for the patient to go into their portal and schedule their appointment. We also get the advantage of the patient verifying their demographic information as well. By allowing another option for how the patient schedules an appointment will increase patient satisfaction. However, for portal scheduling to happen there is set up involved and parameters to set so that schedule managed appropriately.
Here is where the push back comes into play in scheduling. The response I hear the most from operators is: my schedules don’t have time to get demographic and insurance information at the time of scheduling! The reason is most of the time the individuals scheduling the appointments for the providers are also doing front office activities (to which we will talk about later) in the practice. Thus the front desk person is trying to answer the phone, schedule appointments, check people in, etc. My response is if you don’t get the information at scheduling you are setting yourself up for a revenue loss. Typical front-end denials are 30% of your overall denials. So let just say that your overall denial rate for the organization is 10% this would mean that nearly 3% of those denials are resulting from front office mistakes. I would like to point out that all front end denials are avoidable. So let’s put this into numbers instead of a percentage, it makes it a little easier to see the impact. So let’s say each month we have $100,000 in denials that a 30% of the $100,000 would be front end denials. Resulting in $30,000 each month the practice was not able to be reimbursed timely because of a front end error. The revenue impact per year is $30,000 x 12 months = $360,000 a year. That is a lot of missed revenue all because we didn’t want to take the extra 1-2 minutes to gather and verify the data at scheduling. These numbers may not be realistic for your practice, but if you have a large organization, this may be very realistic. Nor am I saying that we couldn’t correct the mistake and get paid, but the payment will be delayed. The question I always ask operators and revenue cycle leaders, if you were able to reduce the front end denials by gathering the data at the time of scheduling how would that impact your practice? The only way to answer that particular question is to truly understand your front end denials and the financial impact like the example above. If you are a revenue cycle leader, you should be communicating the financial impact of the denial rates, not just the percentage. An example, if you explain to your Sr. Leadership that you only have a 3% denial rate, then they may say that is fantastic because there is no reference as to whether 3% is good or bad. However, if you go on to explain that you have a 3% denial rate of $25 million, then the impact is different. Why because now you can quantify what the 3% means and the financial impact. You also need to understand if 3% is good or bad in a sense are you are improving or not improving, 3% may be outstanding since you decrease the denial rate of the front office denials from 10% to 3% or not very good if it is vice versa. It is important for revenue cycle managers to understand the impact so you can explain the financial implications.
Finally, scheduling is just one part of the revenue cycle. However, if you miss here, it will affect your ability to capture revenue. So pay attention to your scheduling process, look at your processes and see if you need to streamline those processes, and most of all don’t be afraid to step out and try something new to get better results.
Tip: I will also strongly recommend that you read Mastering the Patient Flow 4th Edition by Elizabeth Woodcock. You can get this book through the MGMA.com (Medical Group Management Association) or Amazon.com. The reason I am recommending this books is that it goes into great detail about the overall patient flow including the scheduling process. If you are revenue cycle leader, you should have this book regardless if you are a seasoned leader or a new leader starting out in the world of healthcare revenue cycle.
If you have questions or need assistance feel free to contact me below
Cissy Mangrum, MBA, CMPE, CPC
Revitalize Healthcare Solutions
Email: Cissy.Mangrum@cmhealthconsulting.net
Website: www.revitalizehealthcaresolutions.net
Cell: 615-397-5042
Disclaimer – my thoughts are my own and are not associated with any company or system.
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