Leveraging best practices
This presentation is the property of its rightful owner.
Sponsored Links
1 / 14

Leveraging Best Practices PowerPoint PPT Presentation


  • 112 Views
  • Uploaded on
  • Presentation posted in: General

Leveraging Best Practices. Patient Access Management. Discussion Points. Best Practices within the Patient Access Process Core Fundamentals Are these part of your strategy? Best Practices Definition of the best practice How a healthcare organization can support these best practices

Download Presentation

Leveraging Best Practices

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Leveraging best practices

Leveraging Best Practices

Patient Access Management


Discussion points

Discussion Points

  • Best Practices within the Patient Access Process

  • Core Fundamentals

    • Are these part of your strategy?

  • Best Practices

    • Definition of the best practice

    • How a healthcare organization can support these best practices

    • How a vendor should support each of Best Practices

  • Looking ahead into 2014 and beyond

    • Where our focus may be in a few years


  • Patient access best practices

    Patient Access Best Practices

    • Assumptions:

      • Your organization is committed to providing a high level of customer satisfaction

      • Your organization is committed to and supportive of a financial clearance approach

      • We recognize the following statements to be true

        • ‘If you’ve seen one hospital, you’ve seen one hospital’

        • ‘If you’ve seen one successful process, you’ve seen one successful process’


    Core fundamentals

    Core Fundamentals

    • These are ‘must haves’ to be successful with Patient Access Best Practices

    • Defined Patient Access Process

      • Clearly documented and current

      • Belief

  • Hiring the right individuals and appropriate wages

  • Training

    • Investment in a solid training process/unit

    • Adherence to new hire training

    • Regimented training(retraining) calendar for existing employees

      • Consistency!!

  • Investment in technology

  • Organizational ‘buy in’ to a financial clearance process

  • Physician office relationships and scoring (accountability)


  • Patient access and its role in financial clearance

    Patient Access and its role in Financial Clearance

    • By leveraging sound best practices, Patient Access contributes to the accuracy and completeness of the patients account.

      • Scheduling

      • Pre-Registration/Pre-Visit Verification

      • Authorizations/Certifications

      • Point of Service

      • Next day audit

      • Discharge

        Patient Accounting

      • Pre Claim Submission

      • Remittance Advice


    Patient access and its role in financial clearance1

    Patient Access and its role in Financial Clearance

    • Critical data element validation points throughout the Patient Access process.

      • Benefit Information

        • Insurance company

        • Insured

        • Patient share of cost

          • CoPays

          • Deductibles

          • Estimated Patient Responsibility

      • Address Information

        • Current Address

        • Static Address

      • Employer Information

      • Credit Score

        • Fraud detection

        • Payment sources

      • Authorization Requirements


    Patient access best practice workflow scheduling

    Patient Access Best Practice WorkflowScheduling

    • The first interaction with the patient sets the tone for the rest of their experience.

      • Demographic Information Accuracy

        • Patient name

        • Date of birth

        • Social security number

        • Address

        • Telephone number

      • Insurance Information Accuracy

        • Insurance carrier identification

        • Policy Number / Member ID / Subscriber Number

        • Subscriber name

        • Subscriber Relationship

        • Pre-certification / Authorization Phone number

      • Service accuracy

        • Servicing Physician (or Nurse Practitioner)

        • Location

        • Referring Physician information


    Patient access best practice workflow pre registration pre verification

    Patient Access Best Practice WorkflowPre-Registration/Pre-Verification

    • The Pre-Registration process gives the organization the best opportunity to capture and validate.

      • Insurance verification

        • Determine coverage

        • Service level Co-Pays and Deductibles

        • Establish who is insured

        • In Network and Out of Network benefits

      • Address verification

        • If not previously performed in last 90 days

      • Patient Bill Estimation

      • Payment capture of patient cost of share


    Patient access best practice workflow pre registration pre verification1

    Patient Access Best Practice WorkflowPre-Registration/Pre-Verification

    • The Pre-Registration process gives the organization the best opportunity to capture and validate.

      • Credit scoring

        • Establishing patients likelihood to pay

        • Fraud alerting

        • Sources for payment

        • Employer verification

      • Establish Authorization Requirements

        • Patient requirements

        • Provider requirements

      • Pursue funding options for uninsured or under-insured

        • Charity

        • Medicaid

        • Local funding sources

      • Identify Payer Readmission risks


    Patient access best practice workflow point of service

    Patient Access Best Practice WorkflowPoint of Service

    • By establishing a Best Practice Pre-Registration process, the patients experience is that of CARE versus FINANCIAL.

      • Re-verification of benefits:

        • If greater than 24 hours since last verification

        • First day of the month

      • Form execution

      • If ED patient or Urgent Admission:

        • Insurance verification

        • Address Verification

        • Patient Bill Estimation

        • Credit scoring

        • Authorization requirements

        • Uninsured funding

        • Readmission Risk


    Patient access best practice workflow next day audit discharge

    Patient Access Best Practice WorkflowNext Day Audit/Discharge

    • The best processes and technologies do not ensure end user compliancy.

      • Identification of existing discrepancies

        • Insurance benefit

        • Name

        • DOB

        • SS#

        • Member ID

        • Address

        • Diagnosis codes


    Technologies that support best practice workflow

    Technologies that Support Best Practice Workflow

    • A single solution is the key to preventing leakage and end user compliance/acceptance to the best practice workflow.

      • End user familiarity and similar workflow

      • Minimizes integration points with HIS and HER

      • Central repository for data

      • Centralized patient view

      • Single source for data integrity

      • Owned solutions versus multiple partnerships

      • Data content leader

        • Content is king!


    Beyond 2013

    Beyond 2013……

    • The direction the industry is going………

      • More automation……less people

      • Voice enabled technology

      • The patient will play a larger role in the registration process

      • Kiosks/Smart screens

      • Patient portals

      • Increase in services to support ACA requirements


    Questions

    Questions?


  • Login