SIGNATURE Presentation

1. SIGNATUREPresentation OAS GOLD

2. PRESENTED BY Debbie  Harkins  Patient Accounts IT Coordinator, Central Business OfficeBaycare Health System, Oldsmar, FloridaAnnette  Yanna  Senior System AnalystBaycare Health System, Clearwater, FloridaDale  Sahlberg  Senior System AnalystBaycare Health System, Clearwater, Florida

3. What is SIGNATURE ?SIGNATURE is an integrated outpatient management & outpatient accounting application. Front-office functions include registration, scheduling and report writing tools. Business office functions manage accounts receivables with collection tools to maximize reimbursements.

4. SIGNATURE FEATURES Has advanced collection tools (target files) to maximize allowable reimbursements based on payers and collectorsGenerates 1505 medical billing claim forms (combined charge for services and physician - example: chest X-ray)Produces UB04s - same as an inpatient hospital bill with surgery billing for nurse, facility and supplies ( surgeons do their own billing )Has a combined Patient Management and Patient Accounting database (integrated application) that allows charges to be entered and bills produced that same day (day-end)Utilizes SCHEMES that allow multiple insurance plans to meet the different ambulatory care needs

5. A patient was registered at the Imaging site for a annual diagnostic mammogram and ultrasound with Medicare and Medicaid plan providing coverage.Scheme 1 - established with insurance plans Z01 Medicare with a priority of 1 and Z25 Medicaid Fl with a priority of 2

6. The patient was in an auto accident later that day and returned to the Imaging site to have a MRI of the cervical spine. Scheme 2 - established with I16 Auto Allstate Insurance with a priority of 1

7. The patient was scheduled for a knee arthroscopy due to a work related injury that occurred the previous week.Scheme 3 - established with 0041 Commercial Risk Work Comp with a priority of 1

8. The original SIGNATURE application was based on a 3270 terminal design. The Siemens enhanced SIGNATURE version employs browser technology called OAS GOLD.

9. 3270 version

10. Original model design for GOLD

11. The Siemens GOLD model was sent to the Baycare body shopto be reprogrammed, redesigned, repainted and enhanced

12. Baycare SIGNATUREGOLD

13. GOLDhas new graphical features such as: check boxes, radio buttons, labels, selectable lines with banners, combo boxes, a calendar, text boxes, images, scroll bars, data evaluators & controllers

14. Edits on name and address fields to remove bad characters !@#$%/&*)+? that cause interface errors. Example of a bad character #GOLD will automatically remove:

15. Warning notices to prevent the selection of expired insurance plan codes

16. Educational messages to guide the user through a process:

17. One shared main menu with variable options based on job role

18. Users have an access tcl that determines what functions are available

19. When the Accounts Receivable staff signon they see:

20. When the Patient Management staff signon they view:

21. HIPAA compliant notices

22. Billing warning messages Previous accounts had bad information. Previous accounts were bad debt. Previous accounts were charity. Previous accounts had billing problems.

23. Tooltip help has full sentences & detailed information for a field • Inquiry screens are enhanced for faster searches, such as doctor name inquiries with “quick picks”

24. "Minor as the Guarantor" reasons that are easy to select (rather than type in) Radio button selection will appear as a comment

25. VIP BOARD MEMBER FRANCISCAN ORDER CLERGY FOUNDATION FRIEND COMMUNITY LEADER GOVERNMENT OFFICIAL FINANCIAL DONOR STAFF PRIVILEGED PHYSICIAN CELEBRITY

26. Checkmark lights up green if an HDX inquiry is possible for this plan. Eliminates wasted HDX inquiries for unsupported insurance plans.

27. Immediate messages if the data entered is not correct, such as the Insurance Company name.

28. Customized documents and patient face sheets with full insurance company mailing addresses

30. Custom Features

31. Mail statistics: • • 23.6% of all mail in the U.S. is incorrectly addressed. • • 2.7% of the total mail volume is undeliverable as addressed. • • 1 out of every 32 pieces of first-class mail is undeliverable. • Causes: • • Incorrect spelling of street or city • • Misread the address from a document • • Transposed numbers in street or zip code • • Misunderstood the person verbally providing the data

32. Address Verification Benefits • Address validation confirms that a given address is a deliverable address within the United States as defined by the United States Postal Service. • Address verification for bills and statements will also improve the ability to collect fees for services rendered. • The USPS standardizes the address in accordance with USPS guidelines – example: Road will be abbreviated as Rd • Additional Benefits of Address Verification are: • • Improve collections by eliminating returned bills & statements. • • Reduce staff time & costs formerly spent processing returned mail. • • Achieve data integrity through correctness & standardization.

33. Former 3270 screen was unable to verify a patient’s address with the US Post Office

34. The customized GOLD screen can verify online a patient’s address with the US Post Office

35. Address Verification • There is an online address verification for both the patient and guarantor addresses • The verified USPS address is automatically returned to the screen • Corrects the address: 13618 N FLORIDA STREET that should be 13618 N FLORIDA AVE • Corrects the zip code: 33631 that should be33613 • The US Post Office returns a message if more information is needed (apartment or lot number)

37. If the address was not found, then the US Post Office returns the following message: Option:GOLD also can inform the user verbally of an error message.

39. SIGNATURE OAS GOLD IMPLEMENTATIONPROCESS

40. THREE SIGNATURE REGIONS • St Joseph's Diagnostic Center … 4 Imaging Centers • Morton Plant Health Services … 3 Imaging Sites • 1 OP Surgery / Endo site • Baycare Ambulatory Care … 3 Imaging Sites • 2 St Anthony • 1 Med Specialist • 1 OP Surgery Site • 5 Mental Health Sites

41. Analysis Phase • Examined the model SIGNATURE GOLD application at Siemens headquarters • Made site visits to other hospitals • Reviewed the Baycare Invision GOLD application which has a similar design • Made phone calls to other SIGNATURE users • Checked the SNUG users web board for information about current issues • Sent Emails to other SIGNATURE users • Held many meetings and had extensive collaboration between the Central Business Office, Registration areas and Information Services

42. Then a list of the current 3270 issues was compiled.These issues became the reasons SIGNATURE was converted to the GOLD version …

43. CHALLENGES • Experienced significant HDX model issues that were unique to the GOLD combined insurance pathway • Standardized insurance plan codes for all outpatient sites (example: where A01 means AETNA for all sites) • Made revisions prior to the GOLD live to an estimated 1000 pre-registrations that were using the old insurance plans • The 3270 Patient Face Sheet had been customized to include full insurance company mailing addresses - which was converted to print GOLD combined insurance fields • Needed popup panels to notify users when insurance plans were terminated (should not be selected for a new registration) • GOLDnow requires address information be entered for all miscellaneous insurance plans … that used to be an optional PF9 secondary screen in 3270

44. Build Phase • Examined the current 3270 SIGNATURE pathways • Reviewed the Siemens model SIGNATURE design • Created a composite GOLD version of the above two applications

45. Testing Phase • Used predefined scripts for the Patient Management and Accounts Receivable pathways • Verified interface transmissions to other systems (such as IDX) • Validated facesheets & bills were generated • Emulated real patient scenarios for the types of insurances used (managed care, workman's compensation, Medicare, Medicaid, etc …)

46. Integrated Systems Tests • EAD (Enterprise Access Directory) • US Post Office address verification • HDX (insurance eligibility) • ImageCast (Radiology) • EDM (Electronic Data Management) • Lawson - General Ledger & refunds • Target Files • TSI (Managed Care)

47. Training Phase • PM – Patient Management • AR – Accounts Receivable Two training sessions:

48. Training Manual PATIENT MANAGEMENT

49. Training Manual ACCOUNTS RECEIVABLE

50. LIVE Implementation • Morton Plant Hospital went live first • Other two regions are going live in the following months • ACBO (Ambulatory Care Business Office) is the final live event