Coverage
Before. The card on file is copied forward. Inactive plans are discovered as denials.
After. Eligibility exceptions are a same-day list. Staff do not describe a 271 response as an approval.
Process
A visible path from the schedule to the deposit.
The process is a set of queues with owners. It starts with an assessment and becomes daily work only after scope, access, and safeguards are written down.
Patient access
Coverage and authorization before the claim exists.
Registration is checked against the card the patient holds today. A 270/271 eligibility response is read for what it actually contains. Services that usually need authorization are flagged at scheduling, not after a denial.
Before and after the queue exists
Charges
Before. Unbilled visits appear when someone notices a slow month.
After. Signed encounters without charges are a dated queue with an owner.
Coding
Before. A favorite level is applied and changed only if a payer downcodes.
After. The note selects the code. Unsupported levels are queried, not upgraded.
Denials
Before. Large dollars are called first. Repeated small reasons are ignored.
After. Reason codes route the work. Repeating reasons become an edit or a script.
Patients
Before. Statements go out while claims are still in process.
After. Statements follow adjudicated patient responsibility and match the remit.
Onboarding
1. Assessment
We learn the specialty, the systems, the payer mix, and which queues hurt. No patient list is required to start the conversation.
2. Scope
The proposal names the tasks, the system access, and the measures to baseline. Anything not listed is not assumed.
3. Access and safeguards
Named users, minimum necessary roles, and a business associate agreement are in place before claim data moves. Shared logins are not the design.
4. Parallel run
A sample of encounters, remits, and denials is worked while the current process is still visible, so posting rules and edits can be compared.
5. Steady operation
Daily queues and a monthly review replace the project. Upstream fixes are written back into edits and scripts.
Stages in the cycle: Patient access, Charge capture, Coding, Submission, Remittance, Follow-up, Reporting. The public website never asks for the chart. Access to records happens only inside an agreed system.