What's on Your Access Management Wish List?
Why WORKLIST Functionality Should be a Priority!
Patricia Fletcher, Senior Product Consultant, SCI Solutions
"It must have slipped through the cracks." Too much in healthcare slips through the cracks, from forgetting to call to reschedule appointments to not noticing that an appointment scheduled for tomorrow requires pre-authorization. The results of these slip-ups are denied claims, unhappy patients, finger-pointing, extra work, and general inefficiency.
In today's advanced Patient Access departments, Worklist functionality is imperative. If something
must get done, there should be no dependency on memory or Post-It™ notes. Based on rules/workflow
settings, these "To-Do's" should be automatically captured in an online Worklist Module
and assigned to specific users/groups of users, assigned due dates and have built-in escalations
if not done on time.
Worklist capabilities are difficult to describe without examples of benefits, so
the following are just a few of the reasons to put Worklist on your wish list:
Managing Authorizations—
Schedulers can be prompted when an authorization is required for a test, based on the patient's insurance plan. Frequently, callers don't have authorization details at the time of appointment booking, so a Worklist entry would be created to get them assigned to a Pre-Certification/Pre-Authorization team, with a due date of two days before the appointment. The entry will appear on the list in realtime and can be sorted by due date (one of many sort options). The pre-cert team can access all appointments and can enter detailed information directly into the Worklist as necessary.
Pre-Registering Patients—
Schedulers can be prompted to pre-register patients during the scheduling process (if the patient is on the phone), but in other instances, the facility will likely want a dedicated team to perform the pre-registrations. Based on the facility-defined rules, the scheduling solution will populate entries on a Worklist for the pre-reg team to call the patient and complete the task. From within the Worklist, the team will have a prioritized list of patients, their contact information and a link to enter pre-registration details.
Financial Counseling—
A great benefit of the Worklist is the ability to give financial counselors a real-time list of patients to contact to discuss payment arrangements. This Worklist can be triggered by a rule(s) based on a patient not having insurance and booking a high-dollar test or procedure. The workflow might be that the financial counselor first cal s the patient to ensure they will have the means to pay (or agree on a payment schedule) and then, via the Worklist module, the appointment is moved to the pre-reg team to pre-register the patient.
Working Eligibility Denials—
An advanced scheduling solution automatically verifies a patient’s eligibility after an appointment is booked. The application reads the response and if it is denied or if there is an issue with the data, it will post an entry to a Worklist for a team to review. Eligibility denials may be assigned to the same Worklist as pre-registrations, so the issue would be handled during the pre-reg call.
Mass-Rescheduling—
When a provider is suddenly unable to see patients or a
piece of equipment requires unexpected maintenance, a number of appointments must
be canceled and rescheduled. In the process of canceling these appointments, an advanced
scheduling solution not only creates a report of these affected appointments, but also posts
them all to a Worklist. The users assigned to reschedule the appointments can easily view contact
information for the patients. When they reach the patient, they can re-book him/her without re-entering all the appointment details.
Pre-Registering Appointments From Other Systems—An advanced scheduling solution
can accept inbound HL7 schedule messages. In addition to creating the appointment in the scheduling
database, this interface creates a Worklist entry, such as an entry on the pre-reg Worklist. This
gives the pre-reg team one Worklist of all the tasks they need to complete, regardless of where
the appointment was initially scheduled.
Getting ABN Signed By Patient—The Worklist is not just for pre-arrival tasks. If there are tasks to do when a patient arrives, these will be prominently displayed to the front-desk users when they attempt to check-in/register the patient. For example, if a Medical Necessity check does not pass, the system will automatically place an entry on the Worklist for the patient to sign an ABN on arrival.
Conclusion
Those were just a few examples of how Worklist functionality guides and streamlines the Access Management process. Worklists are integral for efficiently automating and managing workflow between your front door (Access) and back office (Finance) departments. Rules, questions and manual actions post To-Do’s to online worklists that integrate with Access Management components, which include Pre-Registration, Medical Necessity, Eligibility Verification, Account Management and Authorization and Referrals.
The sky’s the limit on what a Worklist module can handle. In addition to ensuring tasks are not forgotten and are completed, the Worklist also tracks the status of the work to ensure it gets done.
So why should Worklist be on your wish list? Because it provides the ultimate means of communication between departments, while ensuring that all required tasks are completed prior to patient arrival on the day of service.
client quote:
“With SCI we reduced our lab monthly denials from $23,000 to 0, and increased utilization from 400 average orders a month to 3,230, as well as improved patient, physician and staff satisfaction.”
Eisenhower Medical Center
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