PFS New Direction – An Update

1. PFS New Direction – An Update CMC September 15, 2011

2. History • Original work done in 2001 • Vision • The patient is ready to be seen at the time of the appointment; no delays caused by the PFS Process • The patient will give demographic and insurance information one time • The PFS process is clear and consistent with minimal hand-offs • The PFS process is supported by: • Motivated, well-trained, empowered staff • Effective use of electronic system(s) • Common tools

3. The Past Pre-Visit Scheduling Insurance Verification Registration Obtain Referrals Authorizations Limited Counseling POS Collections Time of Visit Post-Visit Fee Ticket Collection and Completion Registration and Insurance Corrections Coding & Charge Entry / Claim Edits Post-Billing Collection Follow-up and Claim Denials / Appeals Insurance Re-verification and FSC Re-assignment Claim Write-off and/or Bad Debt Losses

4. PFS New Directions Scheduling / Registration / FSC Assignment & Insurance Verification / Obtain Referrals & Pre-Authorizations / Financial Risk Identification/ Financial Counseling Pre-Visit Customer Service Verification / Document Imaging POS Collections More Customer Service Time of Visit Charge Entry Charge Edit Corrections Exceptions Processing Compliance Payment Posting Post-Visit Appeals QA Post-Billing

5. 2011 Work Group Department Participants FPP Participants Charles Albach Connie Belcher Laura Ingersoll Andrew Johnson Karen LaClear Kelley Mullen • Marsha Cannon (OB/GYN) • Cindy Flynn (Pediatrics) • Cindy Gewinner (Surgery) • Dianne Griffith (Orthopaedic Surgery) • Kathy Hoertel (Surgery) • Christy Picard (Medicine) • Dana Sterbenz (Surgery) • Jeanne Thoma (Anesthesiology)

6. 2011 Updates • PFS standards, guidelines, and recommendations – review, edits, additions, and final draft complete • Required registration fields – update complete • PFS policies and procedures – scheduling a 6 hour session to update templates for distribution to departments • Management reports – scheduling a 2 hour session to redesign reports

7. PFS standards, guidelines, & recommendations • Added: • Definitions for FSC and Plan • Process areas for each statement, i.e., compliance, insurance assignment, scheduling, pre-arrival, point-of-service, charge entry, and AR follow-up • Column for which PFS policy and procedure the statement ties to • Pulled insurance assignment out of other areas of the PFS process • Split statements to stand on their own, rather than grouping statements

8. PFS standards, guidelines, & recommendations • Compliance • CMC responsible for an on-going quality assurance plan to define performance measures and accountability • Annual review process • Financial information should only be scanned into GE, not Allscripts • Insurance Assignment • Certified plan assigners are required to attend annual refresher education • Insurance additions, changes, or deletions should be done a the visit level, not the FSC level • All G-plans should be moved to P-Plans within 1 business day • Electronic eligibility responses should be worked within 24 hours

9. PFS standards, guidelines, & recommendations • Scheduling • All departments move to Scheduling Hubs over time (guideline) • Patients will be given an explanation of their financial responsibility • Pre-Arrival • Missing insurance information will be obtained a minimum of 7 business days prior to the appointment date • Referral information is entered on the scheduling appointment data form or AVM visit shell • Patients receive information regarding their appointment prior to arrival (recommendation) • Appointment reminders are done using HIPAA compliant communication methods

10. PFS standards, guidelines, & recommendations • Point of Service • GE/Allscripts used to manage work flow and house information • Appointments statused within one business day • Front desk staff work any remaining alerts • New or changes registration/insurance information immediately entered into GE • No other forms used for the collection of registration information • P-plan assignor available at all times to practice sites • If plan assigned at point of service is not verified, eligibility verification should be done within 2 business days • Use of patient responsibility forms and Medicare advanced beneficiary notice • Insurance card scanned when patient is new to GE, insurance has changed, or annually

11. PFS standards, guidelines, & recommendations • Point of Service • AOB, patient responsibility forms, ABN’s, paper referrals, and arbitration agreements are scanned into GE • Patients asked for co-payments and outstanding departmental balances • Patients asked to make payment on school-wide balances (recommendation) • Charge Entry • Charges should be entered within 48 hours

12. PFS standards, guidelines, & recommendations • AR Follow-up • Default to secondary payor or self-pay when an eligibility rejection is received is discontinued • AR groups will contact the payor or patient before changing the account FSC to self-pay • Rejections for eligibility will be worked at least weekly • FSC change report will be worked daily, if possible, and at least weekly • Self-pay patients who call to report new insurance are referred to PBS • All charges must flow through TES

13. Required Registration Fields • Defined fields that are required versus important to obtain • Added fields users are branched to for completion • Identified which steps in the PFS process fields are required, scheduling, pre-arrival, or point of service • Added fields required for aMPI, Meaningful Use, and Patient Portal

14. Next Steps • Consolidate patient responsibility forms into one, school-wide • PFS policies and procedures – scheduling a 6 hour session to update templates for distribution to departments • Management reports – scheduling a 2 hour session to redesign reports