Patient demographics data
While you, as a front desk might not realize this… this is super critical for medical billing. This alone can mean collecting from insurance payers vs not collecting from the claims. Be VERY, VERY careful about entering demographics data and ALWAYS ensure that you have the absolute latest demographics information from the patient.
Verification of patient’s identity (there’s plenty of patient identity fraud)
You as a front desk or call center person might not realize the impact a patient’s identity fraud might have. But the fines are HUGE and the repercussions are disastrous.
Patient’s medical, family, social & clinical history, medication list
Know that this is the single item that takes most of a technician’s time. The more time a technician takes to fill out patient’s history, Chief complaint etc, the longer it takes to work up a patient. This leads to further delays and longer patient wait times. The longer the patient wait times, patient satisfaction reduces dramatically. As of 2019, CMS has already relaxed the rules around who documents this portion. Try to get this done so it contributes to patients getting in and out the clinic faster. Patients usually don’t do a great job of remembering the medications they are taking when they are at your office.
Various consent forms signed by the patient during patient intake
While we have to deal with documenting patient consents on various items, these can very easily be done by the patient while they are at home as well. Understand that not having consent forms directly exposes a practice / healthcare organization to higher risk / liabilities. An even bigger item to think of – when you want medical records from the patient’s regular provider, you need consent forms signed for them to release the medical records to you. Want to reduce your manual workload of phone calls and want to achieve some parts of your job via SMS and email? You need consent forms for that. Want to collect patient balance due automatically using the credit card on file? (i.e reduce bad debts). You need to get the patient to consent to allow you to charge the card. Get these signatures done – preferably before the patient even visits the office.
Insurance details of the patient (or whether they are a self pay) along with insurance card details.
This one is crucial and you know that you are supposed to get the insurance details MUCH before the patient comes into the office. Once the patient is in the clinic, you don’t really have a way to send them back because their insurance eligibility was not verified – do you? Get the patient’s insurance details, preferably a proof of the patient insurance as well, before the patient ever comes in to see your providers. This directly affects your medical billing department from collecting dues from the patient.
If a patient is self pay, you know very well that they need to be given an estimated cost of care and if they can afford your fees, then they can be given a confirmed appointment.
Insurance eligibility and benefits of patient’s insurance plan
Again, you are directly controlling the outcomes that your medical billing can produce. If you are not checking insurance eligibility for the provider that is going to see the patient, you are bound to screw up. Just because your practice accepts a plan, doesn’t mean that every provider is credentialed with that plan, for that location. Make sure you understand the nuances and make sure that the appointment is made with a provider that is credentialed for that plan. Just because a patient is “eligible” still does not mean that the member benefits cover the CPT that the provider is going to perform. Be aware of this. It is always better to have all pertinent insurance details with enough time on your hands to be able to rectify issues (if any).
Physician referral form, if the patient was referred
This is where the medical marketing department is counting on you. The medical marketing department is tasked with generating physician referrals (in addition to digital marketing). They keep knocking on doors of referring providers to get patient referrals.
In exchange, the referring provider expects their patients to get an appointment ASAP, to be kept in the loop about whether the patient kept the appointment or not, to get consult notes within 24 hours of the patient appointment.
Be a good partner to your referring provider partners by keeping them in the loop about everything – they will reward you with more patient referrals. Meanwhile, open up patient access to the maximum, and the referring partner’s patients will reward you with patient reviews.
Patient’s payment method and details (for credit card of file program)
In the past, payers were covering large portions of a patient’s healthcare costs. These days, the trend is for payers to pass on a larger portion of healthcare costs to the patients (members). This trend is not about to change anytime soon.
So, while in the past, you didn’t really have a credit card on file program with your patients, it is critical for you to do so now. Make sure the consent forms are also signed so that the patient consents to being treated only if you are allowed to collect balance dues directly from their credit card (without having to employ a collection agency).
Collecting copays and prior balance dues (if any)
We have heard all kinds of excuses from patients for not being able to pay copays and from front desk staff from not being able to collect copays.
Understand that collecting copays is REQUIRED by most payers as that’s part of “patient cost sharing”. If you do not collect copays, your provider runs the risk of getting into trouble with the federal antikickback statute, 42 U.S.C. § 1320a-7b. Additionally, none of the payers like that either and eventually your provider will get into trouble for doing so routinely.
Collect copays – each and every time. There’s no 2 ways around this.
Gathering patient reported outcomes
Usually, the technicians do this and the process eats up time. Meanwhile, patients can report their outcomes from the past visit very easily either from home or using a patient intake app as well. You should ensure that the patient does report outcomes from the last visit either electronically or in the office so it would improve clinical workflow efficiencies.
The quicker you are done with a day’s patient load, the faster you can go home 🙂
Hopefully this helps you understand the patient intake process and how you can contribute to the health of your healthcare organization’s clinical, administrative and financial workflows.