Bridging the Gap Between Patient Access and PFS

Report
Bridging the Gap Between Patient
Access and Patient Financial
Services
Lynn Otani, IHHI
Julie Kay, MedAssets
Overview
• Objectives
• PFS vs. Patient Access
• The Integrated Healthcare Holdings, Inc.(IHHI) Story
• Real “work-lives” of IHHI
• Bridging the Gap
• Completing the Revenue Cycle
• Communication
• Technology
• Change
• Final Thoughts
2
Objectives
• Identify communication process barriers between
patient access and patient financial services;
• Determine appropriate communication types that
WORK;
• Learn how technology can play a roll in building this
bridge.
3
Established 2005 with 4 hospitals in Central Orange County, California
Billed from one Central Business Office
4
Western Medical Center Santa Ana
Western Medical Center Anaheim
Chapman Medical Center
Coastal Communities Hospital
Total 762 beds: Acute Care, Cardiac, OB, NICU, Trauma, In and
Outpatient Burn Units, In-Custody patients, Psych, Chemical
Dependence, Obesity and SubAcute Units.
5
PFS vs. Patient Access
• Patient Access is a vital part of the billing and
collections process:
• Percent of data needed for billing originating at registration:
70%
• National average registration error rate: 46%
• Percent of denials that
could be prevented at registration: >50%
• Often an adversarial relationship exists
• Multiple communication barriers
6
Observations
• CBO “tells” Patient Access management what is
needed
•
1) for United Health use new plan code 12346, 12345 has
been deleted.
• 2) MediCal procedure codes xxxxx through xxxxx require a
TAR effective xx/xx/xx
• Patient Access management sends emails or
memos to the staff of the changes needed
• Changes are made until new changes are required,
the staff focus on the new changes and forget the old
changes.
7
Bridging the Gap
• Communication:
• Regular face to face meetings:
•
•
•
•
Cross Department Director level
Management
Staff
Discuss controversial topics
• Organized Communication for Reference
• Shared Drives to file emails and documents
• Binders by subject rather than date
• Standard terminology
Newsletters
With serious and fun topics
8
Bridging the Gap
• Training & Education
• Quick PowerPoints that can be posted
• Peer Review and Audit
• Technology
• Manual processes are labor intensive and often incomplete
due to staff training and understaffing
• Technology can “bridge the gap” by ensuring 100%
compliance for fixed rules
9
Completing the Revenue Cycle
• Treat as one department
• Encourage relationships
• Hold staff meetings with representatives from all
revenue cycle areas
• Contributions to agenda
• Specific scenarios and role playing
• Emphasize the “GOOD” clean account examples
10
COMMUNICATION
11
Eliminate “email wars”
• Rewa Cooper, Director of Admitting, Western
Medical, Santa Ana, CA (IHHI)
12
Reduce Denials
• Christina Jimenez, Admitting Manger Western
Medical Center, Anaheim, CA (IHHI)
13
One Department – Different Locations
• Margie Fitzgerald, Director of Patient Services (DPS)
/ Admitting Manager , Chapman Medical Center,
Orange
• Case management, HIM, ED, and Admitting
14
It Takes a Village
• Email to Patient Access, Health Information Management
and Case Management:
“Zero Collectors worked this case: $120,000 PAID IN FULL 25
days from DISCHARGE!!! This case SCREAMS the undeniable
KUDOS to our PATIENT ACCESS & CASE MANAGEMENT &
BILLING teams for a job done ONCE, done right!!!
THANK YOU ALL: Your great work has really paid off !!!”
-Yaman Kahf, IHHI CBO Director
15
TECHNOLOGY &
AUTOMATION
16
Technology
• Quality Assurance
• Automated Eligibility & Benefits
• Scanners
• ID
• Advance Directives
• Insurance Cards
• Patient Estimation
Productivity and Accuracy Daily
18
Opportunity to Make Corrections
19
Details to Mentor
20
Accurate
Insurance Plan
Selection
Eligibility Integrity
21
Automated Eligibility
& Benefits
Associated with Visit
Eligibility Integrity
22
Opportunity to
Collect Prior
Balances
Access Manager
23
Accurate Patient
Estimates
CarePricer
24
Automated
Payment
Processing
eCash
25
Scripting for Success
eCash
26
Change
• Provides individual opportunity for growth
• Improves overall revenue cycle results
27
Final Outcomes & Results at IHHI
28
Contact Information
• Lynn Otani
[email protected]
(310) 346-1958
• Julie Kay
[email protected]
(972 )333-6454
29

similar documents