Revenue Cycle Time Line: Scheduling

This article has links to allow easy access time line content from Scheduling to Bad Debt Recovery. Use this information as a starting point for planning, SWAT Analysis, or to review policies and procedures for gaps. Create a time line for your facility to assure all participants share the same expectations.

Goals:

· Provide fast, easy access for physician office and direct patient scheduling

· Minimize risk of unreimbursed services and assure clinical services are delivered in the appropriate venue

· Assure the ordering clinician is credentialed to perform the procedure and it is scheduled in the right venue

· Complete Patient Access processing for all patients scheduled at least 2 business days in advance of service date

Note: As technology improves, and more payers allow electronic verification and authorization, the required timeframe will compress.

Activities and Considerations

Clinical and Financial Service Scheduling is complex, requiring understanding and application of both clinical and financial service requirements. Automated systems must support processing. Rules-based systems assist personnel in scheduling services, and help assure correct instructions are relayed to the patient. Likewise, financial rules must be integrated to assure reimbursement.

Revenue Cycle personnel should be involved in this critical control point. The integration of controls between clinical and financial should minimize collection risks from both insurance and patients. Compliance with governmental and third party payers should be confirmed.

An active, financially competent scheduling program must include:

· Order confirmation (including confirmation of physician credentials and service venue)

· Demographic data capture and confirmation

· Insurance Verification

· Medical Necessity Checking

· Authorization Confirmation

· Patient Balance Estimation

· Pre-service Financial Dialog

Each of the functions above is more thoroughly described in the Patient Access Cycle section.

In the event a patient’s scheduled service results in completion of part, but not all service steps delineated above, the Scheduling process must be closely integrated with traditional Patient Access.