Create a New Patient + Treatment Episode

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The first step in recording a patient's journey in the RCM is to create their profile and treatment episode. New patients can be added as Prospective or Admitted Patients, and their episodes will be created automatically. Existing patients who step down in their coverage will need a new treatment episode created for each level of care. Let's review each concept and workflow together! 

Create a Prospective Patient

You can create a Prospective Treatment Episode, which allows you to document patient information, conduct a preliminary eligibility check, and capture insurance benefit details before admission. If admitted, these prospective treatment episodes can be converted into admitted patient episodes, minimizing the need for duplicate data entry. Let's review the workflow together! 

Organizations with CRM integration will have patients created as prospective patients. For more information about the integration, click here. 

    1. Navigate to the Patients section.
    2. Click Add New Patient.
    3. Enter the patient's First Name and Last Name, their Gender (if known), and Birthday.
    4. Add any additional information in the non-required fields.
    5. Next, click the Practice where the treatment will be billed out and click Add Treatment Episode.
    6. Update the Practice dropdown and include an Anticipated Admit Date.
       
    7. Include any additional information in the non-required fields. 
    8. Click Add Insurance to include the insurance information. 
      1. Click Add Patient and Episode Only to complete the prospective patient profile without insurance information.
         
    9. Add the Effective Date of the patient's insurance in the Insurance section.
    10. Next, locate and select the patient's insurance payer from the dropdown. If the payer is not listed, select the New Electronic radial and search for the payer's name in the dropdown. 
    11. Click Add Home Plan and/or Add Behavioral Carve-Out to include carveout information.
       
    12. Click Save And Add Policy Info to add insurance details. 
      1. Click Add Patient, Episode, And Payer Only to skip the eligibility portion.
    13. Toggle Verify Eligibility on Save to run an eligibility check after clicking Finish.
       
    14. Include a copy of the front and back of the patient's insurance card and update the Benefits Assignment when applicable.
    15. Input the Subscriber ID and Patient Relationship to Subscriber. 
      1. If the subscriber's information differs from the patient's, update the following fields: First and Last Name, Birthday, and Gender.
    16. Finally, click Finish to complete the process.
       

Create an Admitted Patient

The process for creating a prospective patient profile can also be used to create a new, admitted patient profile. Let's review it together!

Organizations with EMR integration will have patients created as admitted patients. For more information about the integration, click here. 

    1. Navigate to the Patients section.
    2. Click Add New Patient.
    3. Enter the patient's First Name and Last Name, their Gender (if known), and Birthday.
    4. Add any additional information in the non-required fields.
    5. Next, click the Practice where the treatment will be billed out and click Add Treatment Episode.
    6. Select the Admitted Episode radial.
    7. Update the Practice, A/R Classification, and Admit Date. 
    8. Include any additional information in the non-required fields. 
    9. Add the patient's address and Diagnosis Code (if known).
    10. Click Add Insurance to include the insurance information. 
      1. Click Add Patient and Episode Only to complete the prospective patient profile without insurance information.
    11. Add the Effective Date of the patient's insurance in the Insurance section.
    12. Next, locate and select the patient's insurance payer from the dropdown. If the payer is not listed, select the New Electronic radial and search for the payer's name in the dropdown. 
    13. Click Add Home Plan and/or Add Behavioral Carve-Out to include carveout information.
       
    14. Click Save And Add Policy Info to add insurance details. 
      1. Click Add Patient, Episode, And Payer Only to skip the eligibility portion.
    15. Toggle Verify Eligibility on Save to run an eligibility check after clicking Finish.
       
    16. Include a copy of the front and back of the patient's insurance card and update the Benefits Assignment when applicable.
    17. Input the Subscriber ID and Patient Relationship to Subscriber. 
      1. If the subscriber's information differs from the patient's, update the following fields: First and Last Name, Birthday, and Gender.
    18. Finally, click Finish to complete the process.
       

Create a New Treatment Episode for an Existing Patient

As patients continue their journey with your organization, they may find themselves stepping down in treatment and thus requiring a new treatment episode. It should be noted that prospective treatment episodes can be established for new and existing patients. Let's review the workflow together! 

    1. Navigate to the Patients profile.
    2. Click Create Treatment Episode.
    3. Select the Admitted Episode radial.
    4. Update the Practice, A/R Classification, and Admit Date. 
    5. Include any additional information in the non-required fields. 
    6. Update the patient's address (if needed) and Diagnosis Code (if known) or toggle Import Patient Data from Last Treatment Episode.
    7. Click Add Insurance to include the insurance information. 
      1. Click Add Patient and Episode Only to complete the prospective patient profile without insurance information.
         
    8. Add the Effective Date of the patient's insurance in the Insurance section.
    9. Next, locate and select the patient's insurance payer from the dropdown. If the payer is not listed, select the New Electronic radial and search for the payer's name in the dropdown. 
    10. Click Add Home Plan and/or Add Behavioral Carve-Out to include carveout information.
    11. Click Save And Add Policy Info to add insurance details. 
    12. Toggle Verify Eligibility on Save to run an eligibility check after clicking Finish.
    13. Include a copy of the front and back of the patient's insurance card and update the Benefits Assignment when applicable.
    14. Input the Subscriber ID and Patient Relationship to Subscriber. 
      1. If the subscriber's information differs from the patient's, update the following fields: First and Last Name, Birthday, and Gender.
    15. Finally, click Finish to complete the process.
       

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