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Patient Access Intake Center

Patient Access Intake Center. Transitioning Revenue Cycle Processes to the Front End Kimberly Ryan- Manager of Education Mary Ann Rogers-Project I.T. Specialist. The Goal.

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Patient Access Intake Center

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  1. Patient Access Intake Center Transitioning Revenue Cycle Processes to the Front End Kimberly Ryan- Manager of Education Mary Ann Rogers-Project I.T. Specialist

  2. The Goal To create an Intake Center that will process all ancillary, surgical and inpatient scheduling, authorization, determine patient liability, pre register and collect patient liability.

  3. First Steps • Combined the Centralized Scheduling staff & the • Central Authorization Unit staff to one location • Realigned leadership to 1 Manager & 2 Team Leaders • Developed Career Ladders and combined the job • descriptions to create the Patient Access Intake • Specialist role

  4. First Steps (cont.) • Involved HR in development of compensation plan • Institutued a competency test that would trigger the • compensation plan upon successful completion • * Test designed to prepare staff for NAHAM • ceritifcation exam • Began an aggressive cross training plan to expand over • 18 months

  5. New Moves • Assumed the Surgical Scheduling for three hospitals • and one free standing surgical center • Existing periop staff were transferred to the Intake • Center • Alliances established with Periop Leadership and • Surgeons

  6. New Moves (cont.) • Standardized scheduling processes at the four sites • Cross trained the schedulers to be able to book at all • locations • Trained the OR schedulers on insurance criteria • * Status C screening • * Contracted Insurances • * Some Medical Necessity

  7. Appeals Coordinator • Identified need to have a position dedicated to review • all denials and appeal as quickly as possible • AC is able to identify reason for denial and feed this • information to the Education Manager • Reviews Insurance Newsletters & Bulletins to identify • changes in authorization requirements and parses out • to appropriate service lines as well as Access staff

  8. Patient Access Project IT Specialist • Liason between Patient Access and the Southcoast IT department • Handles all dictionary updates • Tracks and follows all Meditech issues and tasks • Troubleshoots software issues • Investigates new technology possibilities

  9. Accuracy & Accountability • Implemented Davincian Guardian as our QA tool • * customizable • * allows staff to correct errors real time • * serves as an education tool • * includes NEHEN eligibility • Individual and department score cards • * completed registrations • * accuracy rates • * frequency of error types

  10. Upfront Collections • Collecting at most points of registration • Dash Boards assist staff with determining co-pay, • deductible & coinsurance: • Surgery • ED • Imaging Therapies are next • Track daily collection results on a score card • Collected $3.2 million in 2011 • * 28% of potential ED & 18% of potential Ancillaries • * Staff incentive program – 65%

  11. Pre-Registration • All scheduled appointments are pre-registered • Collection attempt at time of pre-registration • Self pay patients reviewed for HSN or other • assistance • Training staff to estimate payment plans and request initial payment at time of service • Patient reports directly to appointment not Admitting

  12. Managed Care Enrollment • Enroll Medicaid and Medicare patients into • contracted Managed Care Plans • Involved most points of registration • Patient Financial Services hosts multiple • community outreach events • Completing Training to Physician Office staff

  13. Physician Practice Buy-In • Must work cohesively with MD practices • Absorbed high dollar Radiology Imaging • authorization process • Services 38 offices ( 148 physician’s) • Provide options on method to access the • Intake Center, i.e. phone, fax, electronic • Customer Service visits

  14. Education Department • Standardized education to all points of registration • Provides all initial training - 2 week class • * Mandatory annual in-services • Computer Access must be approved by Education • Maintains duplicate medical record data and recommends corrective action – HR approved

  15. Revenue Cycle Metrics • Clean claim rate - 94.6% • Days in AR - 32 • Administrative write off percentage - .02% • Upfront collection - $3.2 million • $30 million in documented HSN

  16. National Recognition… • Southcoast was named a Revenue Cycle Award Winner by the Revenue Cycle Academy . • Recognized for: • Top Decile performance among all organizations surveyed in net A/R Days (32.0) • Bad Debt write off’s as a percentage of net revenue (0.2%)

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