EPISODE SUMMARY

Are you tired of grappling with insurance denials due to a simple mismatch in credentialing? Patient registration is more than just a clerical task—it's a key part of your RCM strategy, and this episode zooms in on the next critical step: 

Provider Assignment and Scheduling. Matching the patient to a provider with the right credentials and specialty is crucial for ensuring a smooth eligibility match, preventing costly blunders, and guaranteeing you get paid. This process, which ideally begins on the intake call, requires collecting both patient information (insurance, presenting problem, preferences like language and availability) and using your provider’s preferences and utilization limits to find the best possible fit. Once assigned, getting the patient on the calendar requires granular availability checks and clear 

Appointment Scheduling Guidelines that detail protocols for new patients, handling reschedules, tracking session limits, and managing insurance changes. Finally, managing your wait list is essential; treat it as a powerful tool for converting hot leads, filling cancellation slots, and ensuring optimal provider utilization to protect your revenue and reputation.

KEYWORDS

Scheduling, Intake Process, Eligibility Match, Credentialed Provider, Insurance Denials, EOBs, Provider Utilization, No Shows, Cancellations, Wait List, Patient Preferences, Provider Availability, Appointment Scheduling Guidelines, Out of Network, Medicaid Carve Out

TAKEAWAYS

Assignment is Strategy, Not Clerical: Integrate provider assignment into your RCM strategy, recognizing that matching the patient's needs and insurance to the provider’s credentials and specialty is crucial for getting paid.

Gather Both Sets of Preferences: Don't just collect patient availability and presenting problems. You must also know the provider’s preferences for utilization (caseload capacity), language, and patient type to ensure a good fit and prevent provider burnout.

Address Carve-Outs Early: Be vigilant for specific carve-outs or plans that may not match your provider’s credentialing, even if they appear "in-network" with the general payer. A mismatch can result in a significant loss of revenue.

Document Your Procedures: Create a comprehensive set of Appointment Scheduling Guidelines that includes protocols for booking, tracking session limits/authorizations, handling patient rescheduling, and managing insurance changes or benefit stage changes.

Treat Your Wait List as Revenue: Organize your wait list by key patient and provider match criteria and check it regularly to move patients into open cancellation slots or newly available appointments. Use it to manage provider under-utilization.

CHAPTERS

00:00 Introduction: Setting the Stage for Patient Registration

01:52 From Intake to Calendar: Matching Patients with Providers

04:00 Strategy Behind Provider Assignment

07:24 Managing Provider Utilization

10:30 From Reschedules to No-Shows: Building Strong Scheduling Policies

12:53 The Power of a Well-Managed Waitlist

17:06 The Four Essential Tools for Provider Assignment & Scheduling

21:30 Case Study: From Revenue Loss to Patient Dissatisfaction

24:51 Conclusion

RESOURCES

Today Sponsors: Blueprint

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Images:  Appointment Scheduling Guidelines, Waitlist, Provider Assignment Tool, Provider Availability and Preference Form

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