Ideal practice workflow

1
Ideal Practice Workflow Revenue Maximization and
Cost Efficiency
Contact us 2222 Morris Ave. 2nd Floor, Union,
NJ-07083 Ph (908)-384-1608 Email
info_at_clinicspectrum.com
2
About Us
Clinicspectrum is a healthcare services company
providing outsourcing/back office and technology
solutions for 17 medical billing companies, 600
medical groups/healthcare facilities including
hospitals, and hospital medical records
departments. 
3
Ideal Practice Workflow
Patient engagement for financial purpose begins
with the CALL FOR APPOINTMENT and continues
thereafter until the claim is paid in full. Let's
analyze an ideal practice workflow and steps in
engaging the patient effectively not only for
clinical reasons but for financial reasons as
well.
Appointment call received
Physicians Workflow
Back-end eligibility verification team .
Back-office/Billing Team
Operation Team
Patient Front Desk Process
Patient Engagement by Clinical Assistants
Clinical Reminder Team
4
Appointment Call Received
When a patient calls to make an appointment,
certain key parameters are essential to obtain
over the PHONE for the success of an efficient
workflow management for clinical and financial
planning.
Date of Birth Patients date of birth is noted.
Phone Number Patients phone number is noted for
future reference
Gender Patients gender is recorded.
Patients Name Patients Insurance name is noted
down.
5
Eligibility Determination Parameters
The below 3 parameters are most essential to
obtain over the phone in order to determine
eligibility of the patient and define a prelim
care plan for the patient at the time of service
Patients Insurance Name Patients name that has
been recorded in the insurance.
Patients Primary Physician Patients primary
physician if any and reason for visit.
Insurance ID Patients insurance ID is recorded.
6
Back-end Eligibility Verification Team
An accountable team works on the back-end to
verify all eligibility of patient depending on
his/her visit reason of visit. Depending on
eligibility team creates a financial plan and/or
patients responsibility and communicates with
FRONT DESK for further process.
EHR
EHR/PM System To fast track or for basic
eligibility Electronic Health Record/ Practice
Management systems are used to verify detailed
benefits and authorizations and/or referral
requirements.
Detailed Telephonic Conversation This practice
may require to call Insurance Company
Representative to verify details and benefits .
Highly recommended for Detailed Telephonic
conversation for all new patients.
7
Patient Front Desk Process
Following steps are taken to complete Patients
Check-in and Check-out process
Verifies last date time of last office visit
Verifies demographic information till date
including email id cell.
Check if referral or authorization obtained is
convenient for patient 
Activates Patient portal and provides a brief
video tutorials through email.
Clarifies, if patient was ordered an outside
Test/Procedure/Referral
Addresses any system Alerts for
Financial/Insurance Issues
Completes Appointment Scheduling upon patients
check-out
Collects patient balances due to
co-Insurance/Co-pay (OR) Deductible
8
Patient Engagement by Clinical Assistants
With the below workflow plan, physicians will
save time and are able to walk-in an exam room,
review information and decide whether
tests/procedures completed by their clinical
assistant team were truly necessary.
Generates Medication Reconciliation
Documents Allergies Current Vitals
Validates primary visit
Establishes History
Review preventive test previous treatment
Makes list of procedures to be performed
Distributes questionnaire for diagnostic tests
Reviews clinical protocols
9
Benefits of Clinical Assistants
Time Saving Physicians have to just walk-in,
review information decides whether
tests/procedures completed by their clinical
assistant team were truly necessary
Accountable Care This way clinical team truly
follows Clinical Guidelines to take care of
patients
Care Plan Management This workflow removes gap
and improves risk management
10
Physicians Workflow
This is the workflow of Physicians which makes
medical processes complete fast and efficient.
Performs physical tests, order additional lab
work diagnostic tests or referrals.
Completes electronic chart using DRAGON or
outside Medical Transcription Services.
Review history, allergy, reason of visit
completed tests based on clinical protocols
Spends less time in chart completion MORE time
in patients CARE
Review
Examination
Completion
Care
11
Back-Office/Billing Team

• Physician sends completed chart and the
  information for billing and is transferred
  through Electronic Super bill / Paper Super
  bill or Auto generated Claims through an EHR to
  the billing team.

• Billing team in Medical Practice submits claims
  daily in order to forecast daily/weekly cash
  flow. They maintain a gap of 4 days from date of
  service providing enough time for physicians to
  finish charts, however the cycle of billing must
  be kept intact.

12
(No Transcript)
13
Operation Team
Identify use of Technology/Outsourcing
Cost Reduction Plans Discussed
Monthly meetings are conducted to find available
options to reduce operational costs through
Automation or Outsourcing Services.
14
Clinical Reminder Team
Main role is to do DATA MINING from EHR/Billing
System to identify patients for Horizontal Growth
as well as required visits in office. They send
reminder to patient with the following methods
Email
Patient Portal
Operation Team
SMS
Automated calls/Live Representative calls
Clinical Reminder Team would also be responsible
for Medication Adherence and compliance for
outside tests/referrals for patients. 
15
This workflow plan take practice to next level in
REVENUE / COST / RISK Management and make them
truly accountable in care.
REVENUE
RISK
COST
16
Contact Us
2222 Morris Ave. 2nd Floor,Union, NJ-07083
Website http//clinicspectrum.com/
Phone Number 908.834.1608
Email info_at_Clinicspectrum.com
Clinicspectrum is a healthcare services company
providing outsourcing and back office solutions
for medical billing companies, medical offices,
hospital billing departments, and hospital
medical records departments.