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The business of the patient journey | Managing the patient’s pathway

As demand for private healthcare increases, what can you do to ensure your practice is ready to welcome more insured and self-pay patients and provide a seamless service? In this series, Product and Marketing Liaison and former practice manager, Desné Marston, breaks down the patient journey to look at how the admin side supports the delivery of great care and explains how we can help.

Managing the patient’s pathway

A smooth onboarding process means you can start your relationship with patients on the front foot and helps reassure patients they are in expert hands, as I explained in my last blog. Next, I want to look at the importance of effective admin to support patient care because managing the care pathway is a team effort, requiring clear processes and communication to avoid unnecessary stress and uncertainty.

Ensuring the treatment is covered

Once a patient tells your practice that they’re insured and you’ve verified they have a valid policy (is a speedy shortcut for ePractice Lite and Pro users), check if they have pre-authorisation from their insurer and explain they need to provide this at their first appointment or risk delays while this is sorted out.

Insurers expect policy-holders to contact them if they need to make a claim, such as when they’ve been referred by their GP. If the consultation or treatment is covered under the policy terms, many insurers will give the patient a pre-authorisation number to give to the provider (if they don’t issue pre-authorisation numbers, the patient still needs to confirm they have spoken to their insurer). This can be done over the phone, online or through an app but it makes sense for practice admin staff to be familiar with the authorisation processes for different insurers so they can advise patients and answer their questions.

Getting authorisation ahead of that initial consultation is essential, otherwise the insurer could later reject your invoice on the grounds that they hadn’t been informed. That would leave you in an awkward spot of asking the patient to contact the insurer to get this retro-authorised or invoicing them for the shortfall.

Getting consent for treatment

Of course, it’s then up to you as treating practitioner to assess the patient, make a diagnosis and discuss their options, in line with the standards set by your own professional body (eg the GMC’s Decision-making and consent). Documenting this discussion and recording patients’ informed consent is vital to ensure their wishes are respected and for medico-legal reasons (in the event of a claim, for example). However, every patient is different and it’s not always easy to capture all the relevant points. Once you’ve agreed the next steps, it’s also essential for insured patients to check with their insurer that their policy covers the diagnostic tests or treatment you recommend and any follow-up required. A new pre-authorisation number may be issued but the insurer could use the original one. Even if an insurer has already agreed to a consultation it’s important not to take this for granted. Insurers can turn down claims for various reasons and you don’t want your patient or your practice to get caught out eg because a particular condition, procedure or prescription isn’t covered under their plan.

Bear in mind too that there might be a time limit on pre-authorisation so if a patient wants to go away and consider their options, they may need to contact their insurer again when they return.

However, the big thing to remember about pre-authorisation is that it doesn’t guarantee that the insurer will pay for a consultation or treatment in full, in part or even at all. That’s why it’s so important that your T&Cs spell out that it’s the patient’s responsibility to ensure invoices are paid and that insured patients are responsible for any shortfalls.

At the moment, getting insurer pre-authorisation generally falls to the patient but this makes work for them and is far from ideal for practices if an authorisation number is misheard over the phone and isn’t valid. The good news is that things are changing, thanks to our automated Pre-authorisation service for hospitals. This currently enables them to request pre-authorisation directly from relevant insurers* via our secure online platform and we’re working hard to roll this out to all providers. If you treat patients in a hospital setting, you can get ahead by checking whether they already use the Pre-authorisation service and asking them to share the pre-authorisation number with you for consistency. 

Secure communication

Depending on the outcome of your consultation, it’s up to your practice to manage the patient’s care pathway and ensure they receive the best service every step of the way. That might include sharing test results with another practitioner in a multi-disciplinary team, making arrangements with a hospital for an upcoming procedure or perhaps checking a pre-authorisation number with the insurance company.

It’s important to have a system in place to manage referrals, acting on test results etc and ensure that communication is timely, clear and secure. While technology means it’s no longer necessary to spend hours on the phone to a hospital or insurer, sending confidential personal information by unencrypted email simply isn’t an option within data protection rules. It’s even riskier if you only have a generic departmental email address (such as info@ or secretary@), rather than a named contact as there’s no telling who has access.

Rather than compromise your reputation, you should only use secure encrypted email and/or secure online file-sharing, such as our Secure Messaging solution which is available to ePractice Lite and Pro users. This enables you to communicate and share confidential and personal information with professionals on our global directory of private hospitals, insurers and practitioners. Having access to relevant communications on ePractice rather than another platform saves you time. Plus, you can be confident that this sensitive data is stored on our UK-based computing platform and meets the ICO’s best practice guidance.

*Aviva and Vitality

Supporting patients through what can be an anxious time is just as important as your clinical expertise. From advising them about the need for pre-authorisation to effectively managing the care pathway, your practice admin team can help make the journey easier for patients and their families.    

Discover More

To get started, select Secure Messaging in ePractice and follow these step-by-step instructions or sign up for a free online tutorial with the Healthcode Academy. We offer a 20-minute module – Secure messaging – that takes you through everything, including message settings, the Global Directory, creating your own personal contact list, managing your mailbox and sending emails to multiple recipients.

If you want to learn more about how we can help you manage this and other aspects of the patient journey contact our Business Development team. If you’re already an ePractice user and want to explore the system, check out our guides or book a free 1-2-1 tutorial with one of our friendly experts at the Healthcode Academy

About Desné

Desné worked in the private healthcare sector at various sites in London for over 30 years. She has extensive experience and skills relating to all areas of practice administration, having been a practice manager from the early 90s to 2019 when she joined Healthcode.  

Next time – Invoicing  

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