Two birds with one stone Financially Clearing a Patient & and Improving Patient satisfaction at the same time Manoj Chhabra DCS Global Systems, Inc.
Presentation Agenda Objectives Problem Defined Patient Access Technology Patient Access KPI s DCS Global Solutions
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
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
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!
Advanced Eligibility & Authorizations
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
Revenue Leakage - %age of Total Lost Revenue The Max OOP has doubled in last five years More Insurances require precerts for services.
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
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
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.
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
Authorizations In-Patient Hospital Notifications.
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
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
Sample Fax Forms
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
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
SCREEN SCRAPE TECHNOLOGY
Medical Necessity (ABN & Waiver forms) Medicare and Commercial carriers
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
Medical Necessity - ABN
Coder Worklist Between Patient Discharge to Bill Drop
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**)
E-forms & E-Signature
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
Sample Process Flow 70: Sample Process Flow
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
Patient Bill Estimator
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
Propensity to Pay, Charity Care and Financial Counseling
Best practice
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
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
Patient Wait Time & Surveys
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
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
Outcome Goals Reduction of wait time Instant feedback with customer surveys Real-time reaction to negative feedback
Wait Time
Greeter Flow Walk-In Patient Schedule d Patient Greeter Assigns Coaster Patient Assigned Coaster DCS SurveyCube
Kiosk Flow Walk-In Patient Get a Ticket# Scheduled Patient Kiosk with Touch Pad, Card Reader and Printer
Text Messages Please come to booth# 3
Pager Buzzes and Beeps Registrar paged patient
Kiosk/Tablets going to Patient
Satisfaction Surveys
Sample Survey Report Survey Reports (107)
Wait time Reports
Vendor Selection
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
Vendor Selection
What does DCS GLOBAL do?
ipas- Integrated Patient Access System
Contact Information Lance Mills lmills@dcsglobal.com 972-781-2030 xtn 121 Manoj Chhabra mkc@dcsglobal.com 972-781-2030 xtn 102
Thank you!