Patient Access Intake Center - National Association of Healthcare

Report
SOUTHCOAST HOSPITALS GROUP
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Charlton Memorial Hospital
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St. Luke’s Hospital
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Tobey Hospital
Patient Access Intake Center
Transitioning Revenue Cycle Processes
to the Front End
Kimberly Ryan- Manager of Education
Mary Ann Rogers-Project I.T. Specialist
1
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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.
2
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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
3
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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
4
SOUTHCOAST HOSPITALS GROUP
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Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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
5
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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
6
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
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St. Luke’s Hospital
|
Tobey Hospital
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
7
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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
8
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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
9
SOUTHCOAST HOSPITALS GROUP
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Charlton Memorial Hospital
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St. Luke’s Hospital
|
Tobey Hospital
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%
10
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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
11
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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
12
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
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
13
Tobey Hospital
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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
14
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
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St. Luke’s Hospital
|
Tobey Hospital
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
15
SOUTHCOAST HOSPITALS GROUP
|
Charlton Memorial Hospital
|
St. Luke’s Hospital
|
Tobey Hospital
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%)
16

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