February, 2015:

Patient Access- Just How Accessible Are You?

When asked the question, “are you accessible?” many think of physical accessibility.  However, with a flux of patients having health insurance for the first time, it is prudent to think about new patient access in your practice.  Consider people, process and technology as areas to review.  For example:

1.  Does the scheduling process involve manually looking at each day?  Does the demand for new patient appointments outnumber the supply of visit slots? If the answer is yes, consider reviewing the templates in the practice to ensure staff can easily schedule.  Confirm with your software vendor the practice is using all of the automated functions available.

2.  Are the providers in the practice missing their productivity expectations and generating income less than their target?  If the answer is yes, review the no show and cancellation rates. If the rates are high, it may require a higher number of overall appointments on the schedule to meet the desired target. Review the pre-visit process to ensure you are proactively managing the appointment reminder system and filling cancelled appointments.

3.  Does the practice send patients to the Emergency Room or Urgent Care because it cannot accommodate the volume in the office? Do patients use a retail pharmacy for sick visits because they consistently cannot secure an appointment in the office?

If the answer is yes, the practice may lack an adequate number of “same day” appointments.  If patients are seen outside of the practice, the overall revenue to the group decreases.  Consider the staffing patterns.  Many practices offer Physician Extenders (i.e.  Nurse Practitioners or Physician Assistants) to augment the capacity of the practice.  Physician extenders can offload some of the routine care from the physician thus expanding their bandwidth to see more new patients.  The training and skill set of the physician extenders typically includes education for chronic disease patients and keen assessment skills for acute care visits.  Another less expensive option may be the addition of a Triage Nurse (RN or LPN) to ensure that patients whom need to be seen in the office are prioritized.    Triage offers patients additional instructions and/or the ordering of a short term medication while recuperating at home.

4.  Do the providers in the practice understand the expectations around scheduling including how many clinical hours per week are expected, length of a session, expectations regarding notice for changes and closure of panels to insurance plans? If the answer is no, a review the governance structure, on-boarding process and employment agreement may reveal missed opportunities. Ensure if the practice has included this information and communicated these expectations prior to execution of the employment agreement. The best time to ready new physicians for a patient centered culture is before they are hired. Effective governance is inclusive of physicians and administrative staff and is crucial in ensuring everyone is working towards a common goal and standard.

5.  Does the phone system allow callers to speak to the correct person without being transferred? This is frequently referred to as “first call resolution.” If no, consider the benefits of an updated Telephony system. An Automatic Call Distributer (ACD) allows a caller to select the correct extension (i.e. Speak with a nurse, request a refill or schedule an appointment). The ACD will then “hunt” for the next available phone line in the workque, thus reducing overall wait time for callers. Decreased wait time can improve patient satisfaction.

6.  Does the practice use objective data to set performance goals for the call center or telephone room staff? If you answered no, consider activating the data package and benchmark the performance of the staff against each other and industry standards. Educate staff and managers of the expectations.   Hold staff accountable for their performance. Some industry benchmarks are number of abandoned calls, number of calls answered within 30 seconds and number of calls per each employee to name a few.

7.  Does the medical practice have multiple phone rooms and/or registration units? If yes, review the process and determine if centralizing the pre-visit functions could make the practice more efficient.  Consider scheduling, registration, financial counseling, production, template maintenance, call confirmation and eligibility and verification.       This can easily be accomplished efficiently in a centralized unit with an electronic medical record.

New patients’ entering the practice is an important indicator of growth.   A periodic review of people, process and technologies are essential to the growth strategy of a practice.  Ensure all three components are optimized.  Remove inefficiencies and barriers to ensure easy access for all patients.


Jill Berger-Fiffy, MHA, FACMPEJill Berger-Fiffy


Senior Consultant Culbert Healthcare Solutions

Revenue Cycle: Getting It Right the First Time

There are several steps which can be taken to tighten up front end processes resulting in an enhanced revenue cycle flow. A detailed description of each follows.  They include:

  • Demographic/Insurance capture – Completed either at the time the patient calls to schedule an appointment with a given provider or via a call back from the office at some point prior to the appointment date. Some key data elements required include:
    • Address information ( including: guarantor and the emergency contact/next of kin)
    • Telephone numbers (home and cell phone)
    • Email addresses
    • Subscriber (policy holder) information including address, telephone contact and relationship to patient.
    • Special Needs Info.


  • Eligibility Checking – An automated eligibility check is completed (generally within one week of the scheduled appointment).
  • Patient Verification at time of Check In – All patient’s demographic and insurance is verified for a final time at the time of the appointment check in. This includes scanning of ID and Insurance Card as well as obtaining signatures on all HIPAA and Medical Consent to Treat forms.
  • Referral Management – Patients who require a referral in order to be seen by the provider should be notified (generally within one week of the scheduled visit) that a referral is required. A Waiver signature can be obtained for patients presenting without an approved referral.
  • Coding Process – Comprehensive and accurate coding is completed. This is done to ensure that the billing process is done correctly to avoid having to extensive follow up, or resubmitting rejected claims due to missing or incorrect data.Implementing these suggested processes will pay for itself overtime. The results will be: Better first time billing processes, increased cash flow, a reduction in annual operating budgets, improved customer service and greater patient satisfaction.


Epic Clinical Documentation Improvement-Webinar -Friday February 27th 12:30 est

Culbert Healthcare Solutions invites you to join Jaffer Traish, Epic Practice Director, for a FREE webinar on Friday, February 27th at 12:30 pm Eastern for an insightful look into leveraging CDI initiatives as part of broader clinical and financial improvement programs.


This webinar will discuss and demonstrate the following:

•             The scope and prioritization of CDI initiatives

•             Key approaches and methods for success

•             Important observations and lessons learned


Register today:



Director Epic Practice

Director Epic Practice