Every month, medical practices kiss thousands of dollars goodbye, believing administrative tasks are part and parcel of efficient medical operating systems. Yet these do not refer to the time drains practice administrators already understand – a late patient, a denied claim, a staff member who quits. Instead, these refer to the unsuspecting drains on productivity that take just a few minutes at a time but add up to hours’ worth of lost productivity by week’s end.
What do most practice owners lament about in relation to their financial stability? Missed appointments? Insurance denials? Failing to follow up with patients? While all are clearly obstacles worthy of attention, often the real profit drainers exist in routine administrative tasks occurring dozens of times per day that go unnoticed until someone starts taking minutes and measuring them against practice limitations.
Insurance Verification
Insurance verification is straightforward – but that’s not the case these days. Where there were once a few phone calls and inquiries as the extent of today’s complicated verification process, there are now online portals, hours on hold, and longer timelines, with an insurance verification process taking 15-30 minutes per patient for an admin to call up and do.
And it’s compounded when someone verifies coverage upon appointment making, the staff re-verifies benefits at the time of service. This results in check-in bottlenecks that affect the entire day’s schedule.
Recent trends suggest remote insurance verification support fixes this long-winded in-practice-time job, as this administrative task can be taken care of offsite so that staff in-practice can focus solely on direct patient care and other profitable tasks as their waiting room fills.
That being said, many still don’t realize just how much time they’re personally giving up as insurance verification happens in increments. For example, within a busy practice, in taking all inquiries and tasks associated with a verification process throughout the day, insurance verification can easily account for 2-4 hours daily.
Prior Authorizations
The prior authorization process is exploding. Where prior authorizations were once limited only to high-end surgeries or medications, they’re now accompanied by routine tests and imaging and even some office visits. This requires explanation, documentation, multi-step submission, and potentially even multiple calls.
On top of that, once approved, staff need to follow up with authorization number approval, but also the validity timeline and scope of coverage for better patient management. They need to be educated regarding what’s covered versus not, when they can get their service, and who’s the best person in practice to assist them with such inquiries.
Thus, this time-intensive process occupies worthwhile in-practice hours from general staff who could be more beneficially completing direct implementation tasks. Practices should save their most experienced staff for proper work supervision/oversight instead of giving them work that burdens their abilities to apply learned skills toward something else more productive.
Upon Scheduling An Appointment
Appointment scheduling isn’t as complicated as it used to be – unless you’re talking about insurance verification and referral in tandem with accessing an appointment slot.
Front office staff must now confirm insurance eligibility at the point of appointment scheduling, as well as check with multiple providers for complex cases, who all have their specific referral needs, and then submit inquiries on behalf of one patient to many, which complicates attendance tracking on all fronts.
Specialist referrals were never an issue when primary care physicians had their doors open to see patients from intake to discharge. Now the independent specialists have their systems and no-showed patients re-book, forcing staff to make last-minute accommodations for people already hoping to find quick relief. Appointment scheduling is no longer proactive; it’s reactive and requires an immense amount of follow-through based on what patients want versus what staff believe they can accommodate.
Medical Records Management
Where electronic records were touted as time-saving measures (they’d cut down on handwritten notes), they take up even more time than anticipated previously: managing system updates, password configurations, and privacy issues create a requirement for additional administrative staffing in addition to record-breaking staffing overhead.
Thus, once they’ve spent enough time getting used to portals working, patient messages now require a certain amount of personnel response for test results submission and patient questions addressing whether or not the patient has access to required troubleshooting.
As such, records requests for HIPAA-protected detailing from other providers and patients require administrator oversight as well; they must be reviewed before approval and processed according to guidelines established by a person who knows what should be done.
Billing And Collections Overhead
Medical coding evolves every year as insurance companies require more details for claims submission. Where one set of codes will automatically approve a claim, now it might not without deductible-related details that take specialized training to know which boxes to check.
Practices take extra time attempting collections from increasingly high patient deductibles and copays. Patients even find themselves struggling under these, with higher copays meaning higher out-of-pocket minimums before their treatment can even begin. Thus, administrative managers need to inquire with patients about unpaid balances, payment plans, and financial hardship considerations – the last of which is performed most sensitively per the administration’s best ability.
Payment postings from insurance companies only further detail these necessary steps, with underpayments needing allocation, all translating from complicated conversations – borrowing valuable time from other beneficial endeavors.
Communication Behind Continued Patient Management
Today’s medical practice has a volume of communication surpassing expectations from five years ago: how many calls were made, how many emails received? Patients calling with prescription questions compounded by pharmacy inquiries required extensive coordination efforts between admission-based emails received requesting refills based on authorizations, remains constant communications when one medicine’s approval requires processing over another’s request.
Paperwork continues – even if electronic – involving lab results being sent from one doctor to another or internally based on diagnostic testing still warrants staff involvement – the lab reaches out; someone needs to assess; an abnormal finding is flagged; the doctor may be out; another opinion may be sought – and only then does the patient need communication regarding next steps.
So many steps along the way absorb administrative time – or multiple instances needing repeated actions – that if not accounted for from both sides, additional inefficiencies equal additional late days.
What To Do About It
The best thing to solve administrative drain is to determine whether these issues have skill sets that can be done more efficiently elsewhere at delegated times based on less supervised need, and where direct patient engagement requires immediacy, that task stays with on-site personnel. But administrative burdens fixed without immediate patient impact don’t need immediate implementation during hours with patients present.
Instead, online options or personnel breathing rooms expand better patient retention without sacrificing quality care. Those practices that manage effectively reduce administrative problems by proactively identifying their highest value-added assessments, so staff time can be protected in its most advantageous endeavors.
Not every administrative endeavor has been done this way before, and where successful practices fail to see their potential is by regularly assessing their administrative efforts – resource allocation decisions must be made based on assured progress.
If not, both profitability assessments and patient satisfaction indirectly impacted practices, we would understand better where improvement was necessary relative to expected operations – bureaucratic efficiency has far too many benefits!