Pre-Service (Step 1)
1. The patient is scheduled and pre-registered for service
Pre-Service (Step 2)
2. The encounter record is generated, and the patient and guarantor information is obtained and/or updated as
required.
Pre-Service (Step 3)
3. The requested service is screened for medical necessity; health plan coverage and benefits are verified, and pre-
authorizations are obtained.
Pre-Service (Step 4)
4. The cost of the scheduled service is identified and the patient's health plan and benefits are used to calculate the
price of the services to the patient.
This price typically includes a deductible, coinsurance and/or copayment amounts.
If the service is identified as "not medically necessary," additional processing is required.
,Pre-Service (Step 5)
5. The patient is notified of their financial responsibility including copayments and health plan deductibles, and their
eligibility for financial assistance is assessed.
Time of Service (steps)
1. For scheduled patients, a final account review is completed prior to the patient's arrival.
Ideally, the scheduled patient arrives at the service unit where the pre-registration record is activated, consents are
signed, and co-payments and/or other agreed upon amounts are collected.
Positive patient identification is completed, and the patient is given an armband which corresponds to the activated
account number.
Alternatively, scheduled, pre-processed patients can report to a designated "express arrival" desk located in a
centralized access area upon their arrival.
Time of Service (steps)
2. For unscheduled patients, comprehensive registration and financial processing is completed at the time-of-service.
This process mirrors the work that was completed for the scheduled patients prior to service.
,Post-Service
Post-service includes the account activities that occur after the patient is discharged until the account reaches a zero
balance, such as final coding of all services provided, preparation and submission of claims, payment processing and
balance billing and resolution, as appropriate.
Healthcare Dollars & Sense Pillars
1. Patient financial communications best practices
2. Best practices for price transparency
3. Medical account resolution
Dollars & Sense (Patient Financial Communication)
These common-sense best practices bring consistency, clarity, and transparency to patient financial communications
by outlining steps to help patients understand the cost of services they receive, their insurance coverage, and their
individual responsibility.
Dollars & Sense Time of Service Discussion
The best practices specify that in the ED setting, no patient financial discussions should occur before a patient is
screened and stabilized, in accordance with the local regulations governing the ED.
, Dollars & Sense Emergency Medical Condition
If the medical screening determines that a patient has an emergency medical condition, the financial discussion
should occur during the discharge process. For patients who do not have an emergency medical condition, following
the medical screening, discussion may occur during either the registration or discharge process.
Dollars & Sense Non-emergency Conditions
Outside the ED setting, discussions may take place during the registration or discharge process in a location that does
not disrupt patient flow.
Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite
discharge, the best practices support that choice, providing that the discussion does not interfere with patient care or
disrupt patient flow.
Dollars & Sense Discussions in Advance of Service
Discussions should use the most appropriate means of communication for the patient, and may occur via outbound
contact to the patient, inbound contact from patients making inquiries, or through the scheduling or contact center at
the time an appointment is made.
1. The patient is scheduled and pre-registered for service
Pre-Service (Step 2)
2. The encounter record is generated, and the patient and guarantor information is obtained and/or updated as
required.
Pre-Service (Step 3)
3. The requested service is screened for medical necessity; health plan coverage and benefits are verified, and pre-
authorizations are obtained.
Pre-Service (Step 4)
4. The cost of the scheduled service is identified and the patient's health plan and benefits are used to calculate the
price of the services to the patient.
This price typically includes a deductible, coinsurance and/or copayment amounts.
If the service is identified as "not medically necessary," additional processing is required.
,Pre-Service (Step 5)
5. The patient is notified of their financial responsibility including copayments and health plan deductibles, and their
eligibility for financial assistance is assessed.
Time of Service (steps)
1. For scheduled patients, a final account review is completed prior to the patient's arrival.
Ideally, the scheduled patient arrives at the service unit where the pre-registration record is activated, consents are
signed, and co-payments and/or other agreed upon amounts are collected.
Positive patient identification is completed, and the patient is given an armband which corresponds to the activated
account number.
Alternatively, scheduled, pre-processed patients can report to a designated "express arrival" desk located in a
centralized access area upon their arrival.
Time of Service (steps)
2. For unscheduled patients, comprehensive registration and financial processing is completed at the time-of-service.
This process mirrors the work that was completed for the scheduled patients prior to service.
,Post-Service
Post-service includes the account activities that occur after the patient is discharged until the account reaches a zero
balance, such as final coding of all services provided, preparation and submission of claims, payment processing and
balance billing and resolution, as appropriate.
Healthcare Dollars & Sense Pillars
1. Patient financial communications best practices
2. Best practices for price transparency
3. Medical account resolution
Dollars & Sense (Patient Financial Communication)
These common-sense best practices bring consistency, clarity, and transparency to patient financial communications
by outlining steps to help patients understand the cost of services they receive, their insurance coverage, and their
individual responsibility.
Dollars & Sense Time of Service Discussion
The best practices specify that in the ED setting, no patient financial discussions should occur before a patient is
screened and stabilized, in accordance with the local regulations governing the ED.
, Dollars & Sense Emergency Medical Condition
If the medical screening determines that a patient has an emergency medical condition, the financial discussion
should occur during the discharge process. For patients who do not have an emergency medical condition, following
the medical screening, discussion may occur during either the registration or discharge process.
Dollars & Sense Non-emergency Conditions
Outside the ED setting, discussions may take place during the registration or discharge process in a location that does
not disrupt patient flow.
Across all care settings, if a patient consents to a financial discussion during a medical encounter to expedite
discharge, the best practices support that choice, providing that the discussion does not interfere with patient care or
disrupt patient flow.
Dollars & Sense Discussions in Advance of Service
Discussions should use the most appropriate means of communication for the patient, and may occur via outbound
contact to the patient, inbound contact from patients making inquiries, or through the scheduling or contact center at
the time an appointment is made.
