Two birds with one stone Financially Clearing a Patient & and Improving Patient satisfaction at the same time

Transcription

1 Two birds with one stone Financially Clearing a Patient & and Improving Patient satisfaction at the same time Manoj Chhabra DCS Global Systems, Inc.

2 Presentation Agenda Objectives Problem Defined Patient Access Technology Patient Access KPI s DCS Global Solutions

3 Objectives Develop a patient financial clearance strategy How to Financially clear an insured and a Self-pay patient System automation to Collect money at POS Understand the usage of basic and advanced credit check at registration Understand the necessity to target alternative financial clearance methods at time of registration Leverage automation tools to measure Wait time and Patient Satisfaction How to measure the wait time and gather a Patient Survey at POS

4 Goals Increase POS Cash and Maximize Patient Satisfaction An automated workflow System with paperless process Advanced Eligibility 10 minutes Medical Necessity - 5 minutes Authorizations- 10 minutes e-forms & e-signature - 5 minutes Estimates & POS Collection - 10 minutes Charity Care & Propensity to Pay - 5 minutes Patient Wait time & Patient Satisfaction surveys- 10 minutes Self Service - 5 minutes

5 Increasing Challenges..Significant Opportunities Hospitals are 60% less likely to receive payment once the patient leaves the hospital. Wall Street Journal Healthcare Reform threatens your bottom line To achieve game changing performance Reduce denials Improve patient access experience Increase POS collections In short.integrated Patient Access!

6 Advanced Eligibility & Authorizations

7 The Problem Eligibility accounts for about 20% of denials encountered in patient access Over 100+ industry standard benefit codes Non standard and inconsistent responses from payor Facility needs benefits rather than YES or NO Easy to read responses Lost efficiencies due to multiple payor websites for coverage information 29: The Problem

8 Revenue Leakage - %age of Total Lost Revenue The Max OOP has doubled in last five years More Insurances require precerts for services.

9 Top 10 Insurance Eligibility Denials Incorrect Plan Name Patient is not eligible for that DOS Medicare Denials Patient Name Mismatch Patient DOB Mismatch Patient Gender Mismatch Subscriber ID Mismatch Non-covered Services Medicare HMO Plan MSP Hospice

10 Top 10 Insurance Eligibility Denials Incorrect Plan Name Patient is not eligible for that DOS Medicare Denials Patient Name Mismatch Patient DOB Mismatch Patient Gender Mismatch Subscriber ID Mismatch Non-covered Services Medicare HMO Plan MSP Hospice

11 How do you process error claims? Run Edits on data prior to 270 submission Like bad Subscriber ID Future date submission based on Payor Run Edits Post Eligibility Find the correct Plan Code Highlight Subscriber ID and Name mismatches Run error accounts automatically based on System Errors ( N42, N80) User Defined errors like N63, Invalid Subscriber ID etc. Notify the user after n attempts Unable to obtain eligibility Keep Copies of 271 for n year (s) for appeals.

12 Detailed Medicare Results Medicare Information most required # of days remaining Lifetime limitations/remaining Reserves Remaining deductibles MSP enrollment PPO enrollment HMO s Home Health Care Hospice Procedure Limitations based off of CPT codes

13 Authorizations In-Patient Hospital Notifications.

14 Authorizations Successful approaches Evaluates payor specific rules and determines if auth is needed ER-->in patient Procedure codes etc.. Based on Rule auth rules\auth_rules.xls Continuous monitoring and alerting via worklists Evaluates auths with changes in patient type Achieved via Payor websites Third party websites EDI via 278 Fax 56: Authorizations Successful approaches

15 Sample Submission Rules Evaluates payor specific rules and determines if auth is needed ER-->in patient ( Evaluates auths with changes in patient type) Procedure codes etc.. Based on Rule auth rules\auth_rules.xls Continuous monitoring and alerting via worklists

16 Sample Fax Forms

17 Hospital Authorization Process Flow Facility receives the Order Obtain Demographics Verify Insurance benefits Schedule the Patient AuditLogix QA Identifies if the account needs Precert/Auth or not. DCS Auto initiates the Auth enquiry via 278 I 278 N Screen Scrape call yes Is Pre-cert Needed? no System marks Account with notes such NPR (No Precert Required) If auth Obtained yes ON If Auth is Pending, Update Account and check back again. If Auth is not initiated notify Physician office System Automatically creates a Worklist based on accts missing Auths Update Patient Account with Auth# information System provides several canned reports to see missing Auths

18 How does DCS Achieve Auths Electronic Notification of admission via 278 N Inpatient Supported by few Payors Electronic Auth Enquiry by facility via 278I Out Patient Procedures Supported by Few Payors Auth Enquiry by Screen Scrape All Payors which support Auths via a website Auth Enquiry by Phone for exceptions

19 SCREEN SCRAPE TECHNOLOGY

20 Medical Necessity (ABN & Waiver forms) Medicare and Commercial carriers

21 Medical Necessity -Successful approaches Procedure/Diagnosis matching & non coverage Permissive coverage notifications Textual warning notifications Frequency notifications ABN modifier rules Allows for Custom Rules 57: Medical Necessity -Successful approaches

22 Medical Necessity - ABN

23 Coder Worklist Between Patient Discharge to Bill Drop

24 Sample Type of Edits Medical Necessity Edits (MN***) Correct Coding Initiative Validation (CCI**) Procedure Validation (CPT**) Diagnosis Validation (ICD**) Modifier Validation (MOD**) Place of Service Validation (POS**) Modifier/Procedure Validation (MP***) Usage Validation (USG**) Place of Service/Procedure Validation (PPR**)

25 E-forms & E-Signature

26 E-forms -Successful approaches Document Creation /Generation Bar Code Generation Document Grouping & Printing Document Storage via scanning / uploading Auto Indexing & Document Retrieval Rules based Routing and workflow 67: E-forms -Successful approaches

27 Sample Process Flow 70: Sample Process Flow

28 Improved Process Flow OR Patient reads the form online and signs on the signature pad Patient reads the form on a tablet and signs on the screen 71: Slide71

29 Patient Bill Estimator

30 Patient Estimator - Successful Approaches Increase transparency with automated comprehensive estimates Easy to understand Patient Statement Provides deductible met, copay, co-insurance & final amount based on facility specific contracts & historical data The statement can be delivered electronically & securely

31 Propensity to Pay, Charity Care and Financial Counseling

32 Best practice

33 Financial Counseling - Successful Approaches Identification of Patients who will have trouble paying balances Standard processes for Counseling staff Charity care Screening and automated form filling Payment Plan options 64: Financial Counseling - Successful Approaches

34 Maximizing Collection Opportunities Scheduling Pre-Reg Portal Pre-Reg (Phone) Registration Verify Benefits Collect Order Notify Patient of Estimate & prior balance Verify Demographics Verify Benefits Present Estimate Collect Estimate Present Payment options Verify Patient Info Notify Patient of Estimate Discuss Payment Options Validate Demographics Present Estimate Collect Payment Discuss Payment Options Review Charity Status

35 Patient Wait Time & Surveys

36 Goal The average time patients spend waiting to see a health-care provider is 22 minutes, according to a 2009 report by Press Ganey Associates. The report also noted that patient satisfaction dropped significantly with each five minutes of waiting time. Our goal at was to reduce the time between a patient s scheduled appointment and placement in an exam room to 10 minutes or less for a minimum

37 Identify Problem Areas Process Key Indicator Trigger Point (Goal) Patient Arrival Registration Time Patient Wait Time in Lobby Time to Register a Patient Pre-Service Time Time patient waits prior to service Current Performance Need to Address? 6.5 minutes 7 minutes Yes / No 10 minutes 9 minutes Yes / No 10 minutes 18 minutes Yes / No Service Time Service Time 30 minutes 30 minutes Yes / No

38 Outcome Goals Reduction of wait time Instant feedback with customer surveys Real-time reaction to negative feedback

39 Wait Time

40 Greeter Flow Walk-In Patient Schedule d Patient Greeter Assigns Coaster Patient Assigned Coaster DCS SurveyCube

41 Kiosk Flow Walk-In Patient Get a Ticket# Scheduled Patient Kiosk with Touch Pad, Card Reader and Printer

42 Text Messages Please come to booth# 3

43 Pager Buzzes and Beeps Registrar paged patient

44 Kiosk/Tablets going to Patient

45 Satisfaction Surveys

46 Sample Survey Report Survey Reports (107)

47 Wait time Reports

48 Vendor Selection

49 Vendor Selection When choosing a wait time solution, vendor selection is vital. Partnership with your Hospital/Health system Ability to develop new features Knowledgeable of processes, product lines and industry standards Pre and post go-live support Continued support for current areas as well as future

50 Vendor Selection

51 What does DCS GLOBAL do?

52 ipas- Integrated Patient Access System

53 Contact Information Lance Mills xtn 121 Manoj Chhabra xtn 102

54 Thank you!