Centralizing Patient Access in a System Environment

Report
Presented by MedStar Health
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Presented by:
Cathy Foster, Assistant Vice President
CPAM, CHAM
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MedStar Health
 MedStar Health is a $4.4 billion not-for-profit, regional
healthcare system with a network of 10 hospitals and 20
other health-related businesses across Maryland and the
Washington, D.C., region.
 As the area's largest health system, it is one of the
region's largest employers with almost 30,000 associates
and 5,600 affiliated physicians, all of whom support
MedStar Health's patient-first philosophy that combines
care, compassion and clinical excellence with an emphasis
on customer service.
Revenue Cycle
Account is referred to the designated vendor for
collection
The account balance is
not paid and the account
is sent to bad debt
Teamwork
Patient
makes
appointment
Ins. Verification/ ID
Pt. Deposit/Co-pay
Service
Services rendered /
revenue is recorded
Coding: DX and procedure
Patient makes payment,
or payment
arrangements. Once
account balance is zero
the account is closed
SMS- Account qualifies
for billing (837)
Patient
First 837 (UB04) generates
Innovation
Patient is sent
statement(s) for the
deductible, co-pay, etc
&
is sent to the payor:
Medicare Caremedic / 3rd
Party – Caremedic All
Payor System
Follow-up on pended
and denied claims
Denied Claim: Based on the
denial: 1) write the balance off,
2) appeal with documentation
Payor: pay, pend or
deny claim
Respect
Integrity
Pended Claim: Require s
follow-up with the payor
and or the submission of
additional information
Paid Claim: (835) Payment is
posted, discount applied and
patient is billed for any
residual portion
Who are we?
 MedStar Union Memorial Hospital – Baltimore, MD
 MedStar Good Samaritan Hospital – Baltimore, MD
 MedStar Franklin Square Medical Center – White Marsh, MD
 MedStar Harbor Hospital – Baltimore, MD
 MedStar Washington Hospital Center – Washington, DC
 MedStar Georgetown University Hospital – Washington, DC
 MedStar National Rehabilitation Network – Washington, DC
 MedStar Montgomery Medical Center – Olney, MD
 MedStar St. Mary’s Hospital – Leonardtown, MD
 MedStar Southern Maryland Hospital Center – Clinton, MD
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What do we do?
 Central Financial Clearance for hospital ancillary and surgery
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and inpatient accounts.
Patient Access Training
Billing and Cash Posting
Collections and Customer Service
MedStar Research
Compliance and Regulatory
Renal Billing
Patient Advocacy – Medicaid Eligibility and Financial Assistance
SMS-Invision Front and Back End Revenue Cycle Oversight
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Central Financial Clearance (CFC)
 Located in White Marsh, MD and Arlington, VA
 Insurance verification
 Initiation of authorization
 Estimating charges
 Pre-collection activities
 Demographic verification
 Current state vs. future state Pre-registration
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Old Process
 No interface existed between SMS Invision and PICIS
(OR Scheduling System).
 Facility Patient Access created SMS account during
pre-registration.*
 CFC could not control their workflow as they were
dependent upon the account creation.
 If account was not created timely, could possibly
impact reimbursement and ability to obtain
authorization.
*Pre-registration is defined as speaking to the patient to
validate demographics.
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New Process
 Interface created between SMS Invision and Cerner
SurgiNet Scheduling.
 Immediate account creation upon scheduling allows
for more efficient CFC workflow.
 Required additional registration training for the
facility scheduling staff.
 Validation of positive patient ID required at time of
scheduling to avoid creation of duplicate medical
records.
 CFC and Facility Access Management teams worked
together to create the process.
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New Workflow After Scheduling
Central Financial Clearance
Via HDX, web
or phone
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If no authorization obtained
 CFC contacts the facility when authorizations are still
outstanding within 48 to 24 hours.
 Facility/physician decides whether to accept patient
without definite authorization.
 CFC DOES NOT CANCEL SERVICES.
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Quality Assurance
 CFC staff are continuously monitored to ensure
compliance with registration procedures.
 Accounts are audited and phone calls are screened.
 Follow up customer satisfaction phone calls to preregistered patients.
 Positive and negative feedback provided consistently
between CFC and facilities via emails and regular
meetings.
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Teamwork
 Patient Access and CFC collaborate to assure:
 The highest quality experience to all MedStar patients
 Successful reimbursement for the services provided
 Open communication for consistent performance
improvement
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Presented by:
Barbara Blum, Access Director
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Facts and Figures
 Located at: 201 East University Parkway, Baltimore, MD 21218
 Total licensed beds: 249
 Acute care beds: 231
 Rehab beds: 18
 Annual inpatient admissions: 14,979
 Annual outpatient visits: 105,662
 Annual Emergency Department visits: 58,837
 Associates: 2,416
 Affiliated physicians: 623
 Total net operating revenue: $427.0 million
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Our Specialties
 Hand Center
 Since 1975, people all over the world have placed their hands in ours - Curtis
National Hand Center.
 Today, the Curtis National Hand Center is recognized as the largest, most
experienced hand center in the nation.
 Heart Institute
 Last year alone, our doctors performed more than 880 open-heart surgeries
and 6,100 catheter-based procedures, including nearly 2,000 angioplasties.
 No hospital in Maryland or nationally performs a higher percentage (94
percent) of beating-heart bypass surgeries.
 Orthopaedics and Sports Medicine
 Nationally-recognized for excellence in orthopaedics and sports medicine,
we're home to one of the world's largest hand centers, a comprehensive
sports medicine program, and specialists who are fellowship-trained in care
of the hand, foot and ankle, joint replacement, spine and sports medicine.
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Awards and Recognitions
 Delmarva Foundation Excellence Award for Quality Improvement
 The only hospital in Maryland to receive the award five years in a row.
 America Best Hospitals
 Named one of the nation's top 50 hospitals for diabetes and endocrinology,
orthopaedics, heart care and surgery, and geriatric care by U.S. News & World Report.
 Named among the top three hospitals in Baltimore in U.S. News & World Report's
metro area rankings, 2012.
 Thomson Reuters 100 Top Hospitals®: Cardiovascular Benchmarks for
Success
 Named four times as one of the nation's top 100 heart hospitals by Thomson, a
leading source of information products for the healthcare industry.
 Commission on Cancer
 Cancer program accreditation
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Surgery Patient Check-In
 Patients check in at the centralized outpatient
registration area.
 Patients are tracked through the pre-op Tracking
Board.
 Patient ID and insurance are validated for accuracy.
 Armband is placed on patient.
 Final consents and forms signed and explained.
 Registrar checks Time of Service screen and collects
any patient liabilities due.
 Assure all patients’ questions are answered.
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Goals of On-Site Patient Access
 Decrease registration wait times to avoid delays in
patient care.
 Increase Time of Service collections.
 Assure a positive patient registration and scheduling
experience.
 Accountable for final “quality check” of demographic
and insurance data.
 Admissions representatives are “partners” with CFC in
the patient arrival and clearance process.
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May 2013
Presented by Louanne Diano-Zayas
Director, CSVU, CFC and Cashier’s Office
MedStar Washington Hospital Center
About MWHC
 Licensed 926 beds
 41,127 Inpatients/year
 9,853 Cardiac Caths/year
 1624 Open Heart Surgeries/year
 68,677 Emergency Dept Visits/year
 409,517 Outpatient Visits/year
 2,587 MedSTAR Trauma Visits/year
 Alliance with the Cleveland Clinic
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Why did we Implement GECB?
 To Centralize and Standardize scheduling in a single System
 Inconsistent Policies and Procedures followed to gather information
for scheduling appointment (ex. demographics, insurance, etc.)
 Inconsistent scheduling practices


Depts using Appointment Books
Depts using Multiple Scheduling Systems – Resource Scheduling, EMR,
ARIA
 To enhance the Professional Billing process and enter charges
into a single system
 Professional Charge Entry was done manually
 To Collect real time Professional Time of Service Payments
 Physician Time of Service was a manual transfer process
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Why did we Implement GECB?
 To Enhance Patient through-put
 Unable to view patient appointments for
other departments
 To Integrate with our Electronic Medical
Record
 To Centralize scanning in one system
 To Standardize with Corporate Scheduling &
Registration systems
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How we Did it?
 Piloted 2 Departments – ENT and EYE Center
 Used a Phased approach based on Specialty
 Average of 3 months implementation for Departments
 Trained over 350 Associates (4 day training)
 Manual Appointment Conversion
 Team Approach to Conversion
 Department Management and Associates
 Training and Education Departments
 Consultants
 GECB, INVISION and other IT Representatives
 Created Standardized Policies and Procedures
 Complete Implementation took approximately 1 1/2Year
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Outcomes
 Created a ONE-STOP process for patients for
scheduling, arrival and professional charge entry and
TOS collections
 Centralized and Standardized scheduling in a single
System
 Enhanced the Professional Billing and Time of Service
Collections process
 Standardized policies and procedures
 Reduction in Scanning – Single Repository for Data
 Improved Patient Satisfaction
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Presented by:
Carrie Long, Training Manager
CHAM
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Training Department
 Four team members.
 Trains Patient Access registration procedures and
processes.
 Six hospitals and two business offices located
throughout Baltimore and DC.
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New Hire Training
 Three full days, twice a month.
 Presentation, hands-on practice in Test system, in-
class activities, competency tests.
 Topics covered:
 Registration system (Siemens Invision)
 Patient Search and Duplicate Medical Record
 All major payors; Medicare and MSP, Medicaid, Blue
Cross, Managed Care, etc.
 Integrated eligibility system (Siemens HDX)
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Refresher Training
 Monthly sessions
 Conducted In-Class and by Webinar
 At the facilities and business offices
 Topics include:
 Medicare
 MSP
 Medicaid
 Managed Care
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System Changes
 Obtain agreement from all Access Directors.
 Change goes into Test system.
 Training team and each Access Director will test the
new change.
 Once all agree that change is functioning
appropriately, it will be moved into Production.
 Training Team sends out educational notice to all
facilities.
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Training New Systems
 Trained all surgery schedulers:
 How to conduct a proper patient search
 How to create a new registration
 How to select the appropriate insurance plan
 Training Team was on-site for the week of go-live.
 Maintain constant communication and feedback with
each scheduling office.
 Administered competency test several weeks after golive.
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Training Website
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Webinar Comments
 I thought this was a super professional job. You should all
be proud of this work.
 The Webinar was very well organized and easy to follow.
Thank you.
 The presenter did a great job with the Webinar. She made
the information very comprehendible. I will definitely
attend another Webinar in the future...Kudos to Amy
Gair!!!
 I have a better understanding of how Medicare coverage
works, especially the ESRD which I was not very
comfortable with. Thank you Ladies.
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Monthly Newsletter
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See you at the races!
YUM!!
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