Visit Preauthorizations...any logistical tips?

[hebel]

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I'm an employed outpatient psychiatrist who is currently building up a patient panel (btw, what panel size do you consider full-time?).

The most significant bottleneck to our intake process is getting insurance to pre-authorize the patients visits with me (staff does this, but they are a little short staffed). Does this always have to occur before a visit? Anyone have better success with just doing visits without the pre-auth?

 

[Old&InTheWay]

I know for instance that when my son broke his foot and we were referred to Ortho, we had the appointment before the pre-authorization occurred. So clearly this does happen, but perhaps insurance is unlikely to deny ortho referrals from the ED for fractures.

I suppose it's not too risky if the patient is willing to agree to pay for the visit out of pocket if the insurance does not come through.

 

[calvnandhobbs68]

I know for instance that when my son broke his foot and we were referred to Ortho, we had the appointment before the pre-authorization occurred. So clearly this does happen, but perhaps insurance is unlikely to deny ortho referrals from the ED for fractures.

I suppose it's not too risky if the patient is willing to agree to pay for the visit out of pocket if the insurance does not come through.

Yeah most offices have paperwork along this line anyway (any doctor office). Something along the lines of the patient is ultimately responsible for the bill and if insurance does not cover the patient's claim, they're responsible for the remaining balance.

 

[Sushirolls]

Depending on population you are seeing, full time panel could be 300-450 patients. How often you see people, and what conditions, how much therapy you do all impact that number.

 

[hebel]

Ok, I'm wondering if my organization should just move to allowing intakes before any auths. I'm salaried, so they're paying for the time alot anyway and this pre-auth issue is making my new referral volume rather low for various reasons.

 

[AD04]

If you're salaried, why the rush?

 

[hebel]

If you're salaried, why the rush?

It's chill and I don't hate it, but the growth is really really slowed down by this bottleneck (for a while we're talking 1-2 new patients per WEEK, which is pretty crazy for a psychiatrist with a wide open schedule).

However, I have issues requiring negotiation coming up in the coming months and it helps to be a solid RVU producer. It also helps my appeals to hire more therapists or other staff.

 

[AD04]

This is what I would do then:

1. Find out who is in charge of hiring support staff.

2. Give the e-mail a nice title that grabs their attention.

2. Send an e-mail to the person in charge of hiring support staff and frame it in a way for the hospital to benefit: you can increase productivity which allows the hospital to treat more patients which helps with metrics. This grabs their interest.

3. Explain what can be done in an optimal situation: "I can treat 2 new patients a day instead of 2 new patients a week ... my productivity can increase by 300%" This increases their desire.

3. Explain the problem so the reader understands the situation.

4. Explain the solution: hire more support staff to deal with the bottleneck. Give them a clear action to take. Offer to talk face to face to seal the deal, especially if you're good-looking with the charm of a politician.

Classic AIDA copywriting.

 

[clausewitz2]

This is what I would do then:

1. Find out who is in charge of hiring support staff.

2. Give the e-mail a nice title that grabs their attention.

2. Send an e-mail to the person in charge of hiring support staff and frame it in a way for the hospital to benefit: you can increase productivity which allows the hospital to treat more patients which helps with metrics. This grabs their interest.

3. Explain what can be done in an optimal situation: "I can treat 2 new patients a day instead of 2 new patients a week ... my productivity can increase by 300%" This increases their desire.

3. Explain the problem so the reader understands the situation.

4. Explain the solution: hire more support staff to deal with the bottleneck. Give them a clear action to take. Offer to talk face to face to seal the deal, especially if you're good-looking with the charm of a politician.

Classic AIDA copywriting.

This. Never approach admin executive types with a problem when you can be presenting a solution to them instead.

 

[FlowRate]

I'm an employed outpatient psychiatrist who is currently building up a patient panel (btw, what panel size do you consider full-time?).

Depends on how frequently you want/need to see patients. For a simple example, assume you work 46 weeks per year with 30 hours of scheduled patients per week. Your average patient, over the course of 18 months total, is seen first for an hour then three times at 6-week intervals then three times over the following ~14 months for half an hour (six total half-hour follow ups).

Total patient hours for 1.5 years = 46*30*1.5 = 2070 patient hours.
Average patient over 1.5 years = 4 patient hours
Panel size = 2070/4 = ~500

Change the numbers as you see fit. Could assume more frequent follow-ups. Could use a longer time-frame with more visits to assume that average patient attrition is lower.

Do you have any control over that? I feel like lots of employed positions don't have great panel management.

 

[clausewitz2]

Depends on how frequently you want/need to see patients. For a simple example, assume you work 46 weeks per year with 30 hours of scheduled patients per week. Your average patient, over the course of 18 months total, is seen first for an hour then three times at 6-week intervals then three times over the following ~14 months for half an hour (six total half-hour follow ups).

Total patient hours for 1.5 years = 46*30*1.5 = 2070 patient hours.
Average patient over 1.5 years = 4 patient hours
Panel size = 2070/4 = ~500

Change the numbers as you see fit. Could assume more frequent follow-ups. Could use a longer time-frame with more visits to assume that average patient attrition is lower.

Do you have any control over that? I feel like lots of employed positions don't have great panel management.

I can say for me based on my habits in terms of visit frequency and patient mix roughly 50 established patients per day I am working means I am reasonably full. But yeah, this calculation is going to be extraordinarily sensitive to your initial assumptions. My modal follow-up is probably 4 weeks with a range from weekly to once every 8 weeks (with one outlier of 12 weeks).

 

[Sushirolls]

Pre-Auth for visits from my experience is VA insurance related or medicaid related? These Pre-auths detract from getting in other patients and utilize staff time/resources. Could simply say no to these insurance?

Or its medicare HMO?

 

[romanticscience]

(btw, what panel size do you consider full-time?).

I just ran some numbers for 2021. My practice skews “therapy” focused.

My average face-to-face hours per week is 38 and my average follow up time is 40min. The latter comes from a distribution of follow ups from 15 to 60 min.

Currently, I’m seeing ~100 unique patients every month (weekly to monthly) among a panel of 150 total (remainder being every other month to q3month).

 

[clausewitz2]

I just ran some numbers for 2021. My practice skews “therapy” focused.

My average face-to-face hours per week is 38 and my average follow up time is 40min. The latter comes from a distribution of follow ups from 15 to 60 min.

Currently, I’m seeing ~100 unique patients every month (weekly to monthly) among a panel of 150 total (remainder being every other month to q3month).

Just as a pragmatic scheduling matter how do you avoid having awkward gaps in your schedule with a wide range of follow-up times? Dedicated blocks of time for certain appointment lengths? I have some people who would actually be appropriate for 20 minute follow-ups and would probably prefer them but I am leery of ending up with more dead time I have sat around my office.

 

[Sushirolls]

At the end of my appointments I schedule people myself. I'm able to sort of cluster people together and it helps reduce gaps?

 

[romanticscience]

Just as a pragmatic scheduling matter how do you avoid having awkward gaps in your schedule with a wide range of follow-up times? Dedicated blocks of time for certain appointment lengths? I have some people who would actually be appropriate for 20 minute follow-ups and would probably prefer them but I am leery of ending up with more dead time I have sat around my office.

Actually, 15-minute appointments are usually scheduled for 30-min and the rest of the time turns into a welcome break. The 60-min sessions are also sort of rare.

I schedule people at the end of their appointment; I don't usually do standing appointments. So those who show get dibs on the next week. Those who miss or didn't schedule in-session, have to pick from what's available on my patient portal. The cool thing about my patient portal is that it will search my calendar for the designed time.

At the end of the week, I look at the next and determine the openings. I then go to my patient request form and offer them to new people. I don't schedule new people out further than 2 weeks. I find that people lose motivation and have a higher no-show rate (prob cuz they make apts with other people) when you do that. People are most motivated when they take the step to schedule, so I try to get them in soon to capitalize on that.

There are also a bunch of low risk people on my panel who self-schedule when they see fit. That helps fill the gaps.

It's sort of a quasi-open schedule practice that has filled up naturally. It looks weird that 3 weeks from now, it looks like I have no appointments. However, looking back over months---things always fill!

 

[clausewitz2]

Actually, 15-minute appointments are usually scheduled for 30-min and the rest of the time turns into a welcome break. The 60-min sessions are also sort of rare.

I schedule people at the end of their appointment; I don't usually do standing appointments. So those who show get dibs on the next week. Those who miss or didn't schedule in-session, have to pick from what's available on my patient portal. The cool thing about my patient portal is that it will search my calendar for the designed time.

At the end of the week, I look at the next and determine the openings. I then go to my patient request form and offer them to new people. I don't schedule new people out further than 2 weeks. I find that people lose motivation and have a higher no-show rate (prob cuz they make apts with other people) when you do that. People are most motivated when they take the step to schedule, so I try to get them in soon to capitalize on that.

There are also a bunch of low risk people on my panel who self-schedule when they see fit. That helps fill the gaps.

It's sort of a quasi-open schedule practice that has filled up naturally. It looks weird that 3 weeks from now, it looks like I have no appointments. However, looking back over months---things always fill!

Very useful. Thank you for that. So are you just billing bare 99214 for the 15 minute visits?

I also schedule at end of appointments, definititely helps. I am perhaps a bit too accommodating on requests for specific times so not infrequently have more than one 30 minute gaps with nobody scheduled but not contiguous.

I like your idea re: new people and offering from waiting list, though taking cc before scheduling and no-show fee has cut way down on new patient no-shows.

If I was not planning to open another day in a few months I would probably stop accepting new folks soon. I went through a phase earlier this month when i panicked a little seeing like only 4 people a day scheduled two weeks out and then somehow magically by day of it's 12 and all is good. Still i suppose I could accomplish this with a waiting list. May start doing that next month since I definitely already have intakes scheduled out that far.

 

[romanticscience]

Very useful. Thank you for that. So are you just billing bare 99214 for the 15 minute visits?

I also schedule at end of appointments, definititely helps. I am perhaps a bit too accommodating on requests for specific times so not infrequently have more than one 30 minute gaps with nobody scheduled but not contiguous.

I like your idea re: new people and offering from waiting list, though taking cc before scheduling and no-show fee has cut way down on new patient no-shows.

If I was not planning to open another day in a few months I would probably stop accepting new folks soon. I went through a phase earlier this month when i panicked a little seeing like only 4 people a day scheduled two weeks out and then somehow magically by day of it's 12 and all is good. Still i suppose I could accomplish this with a waiting list. May start doing that next month since I definitely already have intakes scheduled out that far.

Yes. I'm usually good at engaging/evoking someone well enough to fill 30ish minutes; but, some people are to the point and it gets awkward extending the appointment any longer.