- Get a COMPLETE surgery booking order
Typically, the patient arrives at your desk with a surgery note from the surgeon.
Before anything, you need to make sure that the surgeon has provided all the details of the surgery.
At a minimum, you should have CPT(s), ICD(s), surgery location (ASC or hospital), surgeon name (themselves or someone else), any special procedures, anesthesia recommendations (MAC/General etc), urgency of the surgery.
If any of these are missing, then ask the surgeon or the scribe for these details right then.
You cannot process the surgery booking without these details.
- Fill out the surgery center’s pre admission surgery form
This will contain the surgery details and the patient’s insurance information.
If the patient does not have insurance coverage, this will contain the financial responsibility details in it.
Keep in mind that at this point, you do not have the prior authorization number yet.
You will have to update this document with the PA number once you receive the prior authorization from the patient’s payer.
- Pick a surgery date (tentative)
Pick a surgery date based on what the surgeon recommended.
Keep in mind that without prior authorization or medical clearance, your surgery will not happen (in most non-urgent cases). This takes time.
Pick a surgery date (for non urgent cases) that’s around 30 days out.
This gives you enough time to book everything and have a small room for delays/rescheduled appointments.
- Print surgery center booking forms
Look up the patient in your EMR and print the specific ASC / hospital’s required surgery booking forms.
- Set a pre-operative appointment
This would be a good time to set the preoperative and postoperative appointment dates for the patient as well.
These should be set according to the surgery date you picked.
- Get surgery consent signed
Transfer the patient demographics, the surgeon name, the surgery CPT and ICD onto the surgery consent form.
Make sure the patient signs it right then.
You will get the surgeon’s signature later that day (on this form).
- Get signatures on informed consent form
If you have any special procedures in the surgery booking form, transfer the patient’s demographics, the surgeon name, the special procedure details onto the informed consent form.
Make sure the patient signs it right then. You will get the surgeon’s signature later that day (on this form).
- Get pre-operative instructions signed
Your surgery center partner may or may not have a requirement to get pre-operative instructions signed by the patient.
If this is a requirement for your ASC, get these signed from the patient.
- Get signatures on Patient Record Release form
Print out the HIPAA / Patient Record Release form.
Make sure this is signed by the patient before they leave your clinic else you will not be able to receive patient records from the primary care office.
- Set up history and physical clearance appointment
You need to get the patient to visit their primary care for their medical clearance. Typically, your ASC / hospital would have their own H&P form. If not, you should have one from your practice.
- Set up pre admission test appointments
First, find out if your surgeon has written down any pre admission tests ordered or not. If there are, enter these pre admission tests on to the medical clearance request form.
- Set up the COVID test appointment
As you know, you are going to need COVID test results / clearance in addition to the medical clearance for the patient.
I suggest that you make the COVID test appointment on behalf of the patient. This way you control the surgery workflow and do not depend on the patient to be responsible for any step.
- Give the patient their medical clearance forms
Print out the History and physical (medical clearance) form and transfer the patient information, surgery information (ICD, CPT), surgery center details on to the H&P form.
Tell the patient to get this form signed and dated by the primary care physician.
This should include the Preoperative Medical Consultation, Lab and EKG if your surgeon has ordered them.
I prefer to fax this form and the patient record release form over to the primary care office myself.
- Surgery center specific forms
If there are any further instruction forms that are specific to your ASC or your own practice print those out, explain to the patient.
After this, the patient’s part is done and they can go home 🙂
- Signatures on specialty history form
Next, you would have to handle the specialty history form.
This will depend a lot on your specialty. Pull up the patient’s EMR record detail.
There, you will find the specific answers to your specialty history form.
Ensure that this is signed by the admitting physician / surgeon.
- Upload ALL the scanned forms to your EMR
At this point, you should scan all the signed documents and upload them to the patient record in the EMR.
- Start the prior authorization process
As soon as possible, start the prior authorization process.
Each payer has their own set processes. Some payers have their prior authorization requests done online.
Some payers have a standard form that you have to fill out and fax to them.
Fill out the patient, surgery details and send the prior authorization request to the payer.
Of course, with some payers, you will not need prior authorizations and their response will advise you the same.
- Upload proof of prior authorization
It’s best to have a separate fax number for your surgery coordinator. In my opinion, you should get a separate, dedicated fax number for surgeries.
As soon as you get a fax response for the prior authorization, make sure you note the start and expiration date of the prior authorization.
You cannot have the surgery before the PA start date nor can you have the surgery after the PA expiration date.
Upload the prior authorization request to the patient record in the EMR.
- Update your records with prior authorization number
Next, you will have to update the pre admission patient information and insurance sheet with this prior authorization number.
- Update EMR with the medical clearance
The next step would be to wait for the medical clearance form from the patient’s primary care physician office.
My advice is to reach out to the PCP office a day after the patient’s medical clearance appointment and ask for the fax to be sent.
The PCP office might ask you to send over the patient record release (as they should). Once you get the medical clearance form along with the pre admission test results from the primary care physician office, print them out and attach them to the patient record in the EMR.
- Update materials request form
Your next step would be to fill out the Materials Request Form. This will also depend on your specialty.
Collaborate with your surgeon to find the answers for this form.
Once you get the responses, fill out the materials request form (one form) for ALL the surgeries that you are sending across to the ASC or hospital partner.
- Attach the Operative Report Request Form
This would be a good time to attach the Operative Report Request Form for each patient and surgeon as well.
- Send surgery packet to the surgery center
Once you have all these papers signed, packaged together, you can send the entire patient packet to your surgical partners.