Transcript Bridging the Gap Between Patient Access and PFS

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
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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.
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Established 2005 with 4 hospitals in Central Orange County, California
Billed from one Central Business Office
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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.
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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
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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.
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Bridging the Gap
• Communication:
• Regular face to face meetings:
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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
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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
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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
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COMMUNICATION
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Eliminate “email wars”
• Rewa Cooper, Director of Admitting, Western
Medical, Santa Ana, CA (IHHI)
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Reduce Denials
• Christina Jimenez, Admitting Manger Western
Medical Center, Anaheim, CA (IHHI)
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One Department – Different Locations
• Margie Fitzgerald, Director of Patient Services (DPS)
/ Admitting Manager , Chapman Medical Center,
Orange
• Case management, HIM, ED, and Admitting
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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
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TECHNOLOGY &
AUTOMATION
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Technology
• Quality Assurance
• Automated Eligibility & Benefits
• Scanners
• ID
• Advance Directives
• Insurance Cards
• Patient Estimation
Productivity and Accuracy Daily
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Opportunity to Make Corrections
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Details to Mentor
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Accurate
Insurance Plan
Selection
Eligibility Integrity
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Automated Eligibility
& Benefits
Associated with Visit
Eligibility Integrity
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Opportunity to
Collect Prior
Balances
Access Manager
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Accurate Patient
Estimates
CarePricer
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Automated
Payment
Processing
eCash
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Scripting for Success
eCash
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Change
• Provides individual opportunity for growth
• Improves overall revenue cycle results
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Final Outcomes & Results at IHHI
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Contact Information
• Lynn Otani
[email protected]
(310) 346-1958
• Julie Kay
[email protected]
(972 )333-6454
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