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Patient Pre-registrationSave Time for Your Patients and Your Practice

Learning Objectives:
At the end of this activity, you will be able to:
1. Identify steps to design and implement a pre-registration process for your practice;
2. Describe how to develop a pre-registration script;
3. Explain how to identify and train staff to serve as New Patient Coordinators (NPCs);
4. List methods to evaluate the process and gather feedback from staff and new patients.
0.5 Credit CME
How will this module help me incorporate advanced pre-registration into my practice?

  1. Describes four STEPS to make registration easier for new patients.

  2. Provides answers to commonly asked questions about pre-registration.

  3. Shares an example of a practice that successfully adopted pre-registration.

Introduction

A streamlined pre-registration process can save time for the patient and the team.

Pre-registration is conducted by a new patient coordinator (NPC) over the phone or in person prior to the initial visit. This conversation enables the NPC to capture all of the required demographic and payment information in the registration software and enter medical information, including medication list, allergies, and medical history, directly into the electronic health record (EHR) to reduce the data entry work required of clinicians at the patient's initial visit.

Four STEPS for integrating pre-registration into your practice:

  1. Design your pre-registration process.

  2. Develop a pre-registration script.

  3. Identify and train staff to serve as NPCs.

  4. Roll out the new process and gather feedback.

Step 1 Design your pre-registration process.

Quiz Ref IDHave a clear understanding of your current registration process so that you can incorporate pre-registration into your practice workflow. Note that with this approach, all registrations are entered directly into the registration software and EHR without the need for paper forms.

Work as a team to determine the information you will need to collect from patients during pre-registration. This module includes a sample pre-registration process map that you can adapt to meet your needs. This may be used for pre-registration over the phone ahead of the appointment, or for pre-registration in person on the day of the appointment.

Define how you will determine success

Establish metrics that will allow you to compare your current registration process to the new pre-registration process.

Consider using this pre-registration metrics worksheet to identify inefficiencies and set targets. The same worksheet can be used to compare your baseline metrics to measurements made after the pre-registration process is in place to evaluate the impact of the new process. The STEPS Forward™ quality improvement module can help you tackle this change in a stepwise fashion.

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Q&A

  • Who should I include in my discussion about new patient registration?

    You should seek input from everyone involved. This includes front desk staff who answer patient questions about the current registration forms and the nurses or medical assistants (MAs) who handle rooming. The perspectives of physicians and health IT staff will be integral to the planning process as well. If your practice has a patient advisory council, include them in the discussion if possible.

  • Can pre-registration save my practice time and money?

    Yes. Administrative time spent at check-in and during the clinical visit should be significantly reduced. One practice estimated that they could save over $200,000 in physician and team time per 1,000 patients pre-registered at their seven-physician practice using an electronic pre-registration process.1

Step 2 Develop a pre-registration script

Create a pre-registration script to guide the conversation between the patient and the NPC. Quiz Ref IDOrganize this pre-registration script so that it matches the fields in your registration software and EHR. The NPC will save time and make fewer errors if he or she can enter the information in the same order and in the same fields during the pre-registration discussion with each new patient.

Use the script as a training tool. Laminate one copy and post it near the phone where the NPC sits as a reminder until the pre-registration conversation becomes second nature.

To prepare your patients to provide their medical history, you can customize the welcome letter below to send to patients. It can include pre-registration prompts, asking them to prepare a list of their medications, allergies, and their medical history. This will save time and improve accuracy whether the pre-registration occurs over the phone or in person.

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Q&A

  • Does the NPC need to enter the information into the registration software and EHR manually?

    The NPC should be trained to enter patient information directly into your practice's systems during the conversation with the new patient to avoid filling out a paper form then re-entering or scanning the information into the record.

    While this approach may seem time-consuming, it may benefit your team in several ways:

    • Enters higher quality data into the medical record, which will empower your team to have more ownership of the information.

    • Gives the NPC the opportunity to explain why certain information is important to the practice and the patient's medical care.

    • Enables patients to feel more comfortable asking questions about their upcoming visit or about the registration information that the practice needs.

    • Puts patients at ease before meeting a new care team before their appointment.

Graphic Jump Location
Q&A
Step 3 Identify and train staff to serve as NPCs.

NPCs should have exceptional customer service and telephone skills, as well as competency with your practice registration software and EHR. The NPC can be a front office staff person designated to handle new patient registration as part of his or her responsibilities, a current MA, or patient service representative (PSR). Depending on your practice specialty and patient complexity, a nurse may be a more natural fit for this position.

Quiz Ref IDThe NPC's responsibilities include:

  • Guiding patients through the pre-registration process.

  • Informing the patient about any items to bring to the appointment, such as medications and prior medical records.

  • Obtaining accurate and complete demographic, insurance, and medical information.

  • Checking patient insurance eligibility and informing the patient of any co-pay amounts that will be due at the time of service.

  • Scheduling the patient's appointment, giving the patient a copy of the appointment date/time, parking instructions, and directions to your practice.

  • Scheduling any laboratory or other tests based on your practice's protocols.

  • Answering questions about the registration process, practice and medical team.

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Q&A

  • What training should I provide for my MA or PSR to transition into the NPC role?

    MAs often need some procedural or workflow training regarding the registration process. PSRs may need training on basic medical terminology and documenting in the EHR. Shadowing can be an effective way for MAs and PSRs to learn from your check-in team, schedulers, physicians, and nurses. If you have a Medical Assistant Professional Development Program, consider adding a session on pre-registration to train your MAs. To make the most out of your training program, your PSRs could learn from your MAs about the essential clinical information to be entered into the chart before the patient visit.

  • Where should the NPC sit given to facilitate the conversation about the patient's medical history?

    If possible, the Quiz Ref IDNPCs should have a small office with a door that could be closed for privacy, but with enough room for a family member to be present if requested by the patient. This is particularly helpful if your practice serves a large elderly population that is more likely to have family members or caregivers with them at their appointments.

  • Can the NPC collect insurance information at the time of pre-registration?

    Yes. The NPC should run an insurance eligibility check and/or review the patient's benefits to explain his or her co-pay responsibility. If you are not in the patient's network, the NPC can explain what that means and confirm that the patient wants to keep the appointment.

  • How many NPCs will my practice need?

    The number of NPCs will depend on the number of new patients you anticipate. By way of example, two NPCs worked well in a practice of seven physicians. In that setting, three of the seven physicians were new and needed to build their patient panels, so they needed additional support to pre-register new patients. The second NPC covered lunch breaks and assisted walk-in patients to minimize or eliminate wait time. Your practice may find that only one NPC is needed. You may also consider cross-training another MA or PSR to be able to cover for a single NPC.

  • Will all of the NPC's time need to be dedicated to pre-registration, or can this person fulfill another role on my team?

    The NPC should have sufficient uninterrupted time to thoroughly collect all important information, accurately enter it into the registration software and EHR, and most importantly, make new patients feel welcome at the practice. If NPCs haven other responsibilities in the practice, you may find that the best approach is dedicating one day a week or half of each workday to pre-registration tasks. If you choose to do some or all of the pre-registration over the phone you will be able to batch the work more easily than if pre-registration is done only in person, at the time of the visit.

Step 4 Roll out the new process and gather feedback.

Start implementing the pre-registration process with new patients who still need to be scheduled. As time permits, reach out to new patients who have already been scheduled.

Solicit quarterly feedback from new patients and your team. Anecdotal feedback from physicians, nurses, and MAs about the quality of the clinical information entered during pre-registration will help improve the process. Prepare continuous training or education for the NPCs based on this feedback. Review your metrics worksheet to determine how pre-registration has impacted your practice.

Consider customizing the run chart below to visually display the results.

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Q&A

  • How long should it take to complete registration with the new process?

    Quiz Ref IDPre-registration by an NPC should take approximately 15 to 20 minutes.

  • What about walk-in new patients?

    Patients who walk into the clinic can meet with the NPC in person for 15 to 20 minutes to complete pre-registration before they see the medical team. This will ease the burden on the PSRs who are checking in other patients, and it will ensure that the clinical team has all of the information they need for an efficient, effective visit.

    The same approach can be applied to established patients who need to update demographic or insurance information before their appointments.

  • What results could I see with pre-registration?

    Results of using pre-registration may include increased patient satisfaction, increased provider and staff satisfaction, reduced new patient appointment times, reduced new patient check-in times, and more efficient use of resources.

  • How quickly would we see results with pre-registration?

    It depends. The efficiency of your current registration practice, practice size, and NPC resources are all factors. One practice reported that it took approximately three months to achieve consistently accurate pre-registration data entry on the first try with no follow-up needed to fill in missing information that would be essential for the patient's first visit.

Conclusion

Standardizing and streamlining new patient visits with pre-registration can save your practice time and money while providing a better experience to both patients and staff. The NPC can be a welcoming presence, and having an NPC reach out to new patients before their first appointment can help everyone have more efficient visits.

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AMA Pearls

Pre-registration saves time and reduces paperwork.

Helping patients with registration saves the patient time trying to understand and accurately answer registration questions presented to them in paper form. Physicians and other care team members can also spend more time on the visit and less time on paperwork while being confident they have a complete medical history.

Use technology to your advantage.

Eliminating paper and entering information directly into your practice's registration software and EHR prevents mistakes. Emerging technologies may further streamline patient registration, including patient portals or kiosks that allow patients to enter a great deal of registration information themselves.

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STEPS Forward™ presents actionable, practical toolkits and customizable resources that you can use to successfully implement meaningful and transformative change in your practice or organization. See How it Works

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

0.5 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;

0.5 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;

0.5 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program; and

0.5 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program;

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Article Information

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this enduring material activity for a maximum of .50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Target Audience: This activity is designed to meet the educational needs of physicians, practice administrators, and allied health professionals.

*Disclaimer: Individuals below who are marked with an asterisk contributed towards Version 1 of this learning activity.

Statement of Competency: This activity is designed to address the following ABMS/ACGME competencies: practice-based learning and improvement, interpersonal and communications skills, professionalism, systems-based practice, interdisciplinary teamwork, quality improvement and informatics.

Planning Committee:

  • Christine A. Sinsky, MD, FACP, Vice President, Professional Satisfaction, American Medical Association*

  • Marie Brown, MD, MACP, Senior Physician Advisor, Professional Satisfaction and Practice Sustainability, American Medical Association & Associate Professor, Rush Medical College, Rush University Medical Center

  • Renee DuBois, MPH, Senior Practice Transformation Advisor, Professional Satisfaction and Practice Sustainability, American Medical Association

  • Brittany Thele, MS, Program Administrator, Professional Satisfaction and Practice Sustainability, American Medical Association

  • Mary Kelly, CME Program Committee, American Medical Association

  • Alejandro Aparicio, MD, Director, Medical Education Programs, American Medical Association*

  • Rita LePard, CME Program Committee, American Medical Association*

  • Becca Moran, MPH, Program Administrator, Professional Satisfaction and Practice Sustainability, American Medical Association*

  • Ellie Rajcevich, MPA, Practice Development Advisor, Professional Satisfaction and Practice Sustainability, American Medical Association*

  • Sam Reynolds, MBA, Director, Professional Satisfaction and Practice Sustainability, American Medical Association*

Content Reviewers:

  • J. James Rohack, MD, FACC, FACP, Senior Advisor and former President, American Medical Association

  • Renee DuBois, MPH, Senior Practice Transformation Advisor, Professional Satisfaction and Practice Sustainability, American Medical Association & Associate Professor, Rush Medical College, Rush University Medical Center

  • Brittany Thele, MS, Program Administrator, Professional Satisfaction and Practice Sustainability, American Medical Association

  • Jessica Reimer, PhD, Medical Writer, HealthComms, Inc.

  • Bruce Bagley, MD, Senior Advisor, Professional Satisfaction and Practice Sustainability, American Medical Association*

  • John Hickner, MD, MSc, Professor and Head, Family Medicine, University of Illinois at Chicago*

  • Mark Potter, MD, Associate Professor of Clinical Family Medicine, University of Illinois at Chicago*

  • Becca Moran, MPH, Program Administrator, Professional Satisfaction and Practice Sustainability, American Medical Association*

  • Ellie Rajcevich, MPA, Practice Development Advisor, Professional Satisfaction and Practice Sustainability, American Medical Association*

About the AMA Professional Satisfaction and Practice Sustainability group: The AMA Professional Satisfaction and Practice Sustainability group has been tasked with developing and promoting innovative strategies that create sustainable practices. Leveraging findings from the 2013 AMA/RAND Health study, “Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy,” and other research sources, the group developed a series of practice transformation strategies. Each has the potential to reduce or eliminate inefficiency in broader office-based physician practices and improve health outcomes, increase operational productivity and reduce health care costs.

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

ABMS MOC: Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Maintenance of Certification (“MOC”) Activities, this activity has met the requirements as an MOC Part II CME Activity. Please review the ABMS Continuing Certification Directory to see what ABMS Member Boards have accepted this activity.

Renewal Date: 04/25/2019

References
1.
Asante Physician Partners Family Medicine. (2016).  Adopting Patient Pre-Registration in Grants Pass, OR: A Case Study. (STEPS Forward™)
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